VN057 Gerontology 9

• Addendum to last week-look in Angel for the Kubler-Ross stages of grief. I forgot to put on the ppt.

Chapter 16

Sexuality and Aging

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Factors that Affect Sexuality of Older Adults

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Normal Changes in Women

• changes in the reproductive system related to decreased levels of progesterone and estrogen

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Changes in Women

• The good– More relaxed about sexuality• Experience/assertiveness• No pregnancy worries• Less life stress

Changes in Women (cont.)• The not so good• Increased STD risk – Tissue thinning– No pregnancy worry=no condom

• discomfort or pain during intercourse– Irritation of the external genitals – Thinning and dryness of the vaginal walls – Alteration in vaginal flora• increased risk for vaginal yeast infections

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Erectile Dysfunction in Men

• orgasm takes longer to achieve and has a shorter duration than at a younger age

• Ejaculation less forceful-smaller volume of seminal fluid is released

• Loss of erection occurs quickly after orgasm• The time between orgasms increases, and

orgasm may not occur with every episode of sexual intercourse

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Illness and Decreased Sexual Function

• Many disease processes & medications interfere with normal sexual function – Some medications enhance sexual function, even

some that aren’t designed to do so • Incontinence does not interfere with sexual

relations but may cause some people to avoid sex because of the risk of embarrassment

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Illness and Decreased Sexual Function (cont.)

• Joint pain resulting from arthritis can interfere with sexual activity

• Cardiac problems can interfere with normal sexual activity-more from fear than from actual danger– Circulation problems affect ALL organs…..

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Illness and Decreased Sexual Function (cont.)

• Stroke need not prevent sexual activity• Neither hysterectomy nor mastectomy

changes sexual functioning– BUT.. They often cause body image problems

• Depression- can decrease sexual interest & lead to decreased response to intimacy– Many antidepressants cause sexual side effects

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Alcohol and Medications

• Excessive alcohol intake– delayed orgasm in women– loss of the ability to achieve or maintain erection in

men• Digitalis, tranquilizers, diuretics, antihypertensives,

antihistamines, antidepressants, and even some medications used to treat GERD are likely to cause sexual problems for men and women

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Loss of Partner

• Single older women experience more of a problem than single older men

• By age 85, there are 100 single women for every 39 single men

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Loss of Partner (cont.)

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Marriage and Older Adults

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Marriage

• many different responses- particularly from families• Pensions, insurance benefits, and other financial

concerns may be contingent on the person’s remaining single

• Some choose to live together without marrying– can be a difficult decision for them and their families

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Caregivers and the Sexuality of Older Adults

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Caregivers

• Young people often uncomfortable with the thought of sexual activity

• health care professionals may be unaware of or uncomfortable about addressing the sexual needs of older adults

• Fear, shame, or embarrassment causes many older people to hide their sexual interests and activity, even from health care professionals

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Sexual Health and Sexual Orientation

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Sexual Health

• Older adults often are not considered when sexually transmitted diseases are discussed, yet 10% of acquired immunodeficiency syndrome (AIDS) cases occur in people older than 50 years

• All sexually active individuals, no matter what their age, should use safe sex practices

• The risk for sexually transmitted disease does not disappear with age

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Sexual Orientation

• People may be more comfortable expressing sexual orientation as they age

• Health care providers must be careful to recognize the sexual needs and concerns of older lesbian, gay, and transgendered people

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Privacy and Personal Rights of Older Adults

• Obtaining adequate privacy may be difficult even for married couples who reside in the same institution, particularly if regular medical or nursing care is necessary

• Touching, hand-holding, and cuddling are encouraged

• A closed door must be respected when privacy for intimacy is desired

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Touch and Affection

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• Touch and affection are human needs, even when sexual expression isn’t possible

Chapter 17

Care of Aging Skinand Mucous Membranes

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Skin Color

• Examination- good, preferably natural, light– Compare one side of the body with the other– Use touch for skin temperature or the presence of

rashes or irritation• Color changes-can indicate many problems– Pallor -erythema– cyanosis– jaundice

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Dry Skin

• most common problem of aging– itching (pruritus)– Burning– cracking of the skin

• Common- habit of scratching or picking dry or cracked skin– increasing their risk for further tissue damage and

infection

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Assessing Skin Impairment

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Dry, Scaly Skin

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Rashes and Irritations

• Common causes: Medications, communicable diseases, contact with chemicals

• Allergic response to medications– diffuse rashes over the body

• Scabies-superficial infection caused by a parasitic mite (Sarcoptes scabiei) that burrows under the skin

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Scabies Lesions

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Pigmentation

• Changes in pigmentation common with aging• Some, like acne rosacea can be treated with

topical medications• Changes in the size or pigmentation of moles

greater significance – changes may = presence of a precancerous or

cancerous condition that needs immediate medical attention

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Tissue Integrity

• Wounds of any size increase risk for infection often need costly treatments

• Skin tears, abrasions, lacerations, and ulcers most often result from friction, shearing force, moisture, and pressure

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Pressure Ulcers

• Risk: compromised circulation, restricted mobility, altered level of consciousness, fecal or urinary incontinence, or nutritional problems

• Excessive pressure on tissues, particularly over bony prominences, can quickly lead to skin breakdown

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Pressure Ulcers (cont.)

• Ulcer development depends on the amount of pressure, length of time pressure is exerted, and underlying status of the tissues involved

• Pressure ulcers are categorized or staged based on their appearance and depth of tissue penetration

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Risk Factors for Pressure Ulcers

• Immobility• Inactivity• Incontinence• Malnutrition• Diminished sensation, decreased mental

status• Impaired skin integrity

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Braden Scale for Predicting Pressure Sore Risk

• The Braden Scale takes into consideration the following factors when assessing for pressure ulcer risk– Sensory perception– Moisture– Activity– Mobility– Nutrition

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Bony Prominences and Common Pressure Ulcer Sites

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Pressure Ulcers

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A common complaint in older adults that may be caused by dryness, irritation, or infection of the skin is:A. decubitus.B. bruising.C. pruritus.D. alopecia.

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Amount, Distribution, Appearance, and Consistency

of Hair• Hair -men & women becomes thinner and

more fine• Men-lose more hair than women, although

some men retain a full head of hair throughout life

• Male pattern baldness-progressive loss of hair at the temples and back of the head

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Hair (cont.)

• Sudden &excessive loss (alopecia) or breakage can indicate a systemic problem

• Decreased or lack of hair on lower legs—especially with very dry, scaly, discolored or flaky skin with weak or absent pedal pulses—indicates decreased blood supply to the lower extremities

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Feet

• many people are unable to bend to view feet, a family member or friend can perform inspection for independent older adults

• Many neglect their feet simply because they cannot see or reach [or feel] them

• Unless foot inspection is done on a regular schedule, severe problems can occur before anyone is aware of them

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Common Foot Problems

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Foot ulcers

Foot ulcers

Nails

• Aging results in hyperkeratosis of the nails, particularly the toenails

• Thick, hard nails are difficult to cut using normal foot care equipment

• The strength and effort required to cut these nails may exceed an older person’s abilities, resulting in overgrowth

• Fungi cause the nails to become thick, brittle, misshapen, and discolored

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nails

Other Common Foot Problems

• Corns, calluses, blisters, and bunions-years of poorly fitted footwear

• Many use OTC foot remedies or attempt to remove corns or calluses– Dangerous-increases risk for infections– Can cause breaks in skin-combined with poor

circulation can lead to ulcers– may necessitate amputation of a toe, toes, or

entire foot/leg

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Nursing Interventions for Impaired Skin Integrity

• Assess level of impairment and contributing factors

• Institute measures to reduce risk for skin and tissue breakdown

• Institute measures to promote tissue healing• Provide good foot care

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Treatment Options

• Treatment options for pressure ulcers are dependent on the stage

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A superficial infection caused by a parasitic mite that burrows under the skin is:A. lice.B. scabies.C. ringworm.D. leukoplakia.

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Objectives

• Identify-who are most at risk for problems related to the skin and mucous membranes

• Describe interventions that assist older adults in maintaining intact skin and mucous membranes

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Nursing Process for Impaired Oral Mucous Membranes

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Dental Caries

• Tooth decay, loose teeth, and lost teeth are ongoing problems in the population

• Poor nutrition and decreased appetite can often be attributed to dental problems

• Decay, or caries-caused by bacteria that penetrate through the enamel shield of the tooth and cause destruction

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Periodontal Disease

• A less obvious but potentially more serious complication of poor oral care

• Food debris & plaque build up in the mouth and on the teeth when oral hygiene is inadequate

• Activity of bacteria on debris cause bad breath, or halitosis.– often disturbing to the older person and to anyone

in close contact68

Periodontal Disease (cont.)

• Gingivitis causes gum swelling, tenderness, and bleeding and eventually leads to recession of the gum tissue away from the tooth

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Pain

• Dental caries and periodontal disease– most common reasons for oral pain– oral lesions such as stomatitis or altered

sensations in the mouth are also reported• Pain may be limited to the oral cavity or may

affect the face and jaw• Oral pain can cause loss of appetite,

decreased food intake, a negative effect on the overall quality of an older person’s life

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Dentures

• Partial plates tend to catch particles of food and may weaken healthy teeth

• Complete dentures-difficult to fit• Dentures may not fit properly if a significant

amount of weight is gained or lost• Dentures can cause irritation, inflammation,

and ulceration of gums and oral mucous membranes

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Dry Mouth

• Xerostomia, or dry mouth is common– may result from normal age-related reduction in saliva

secretion, medication side effects inadequate hydration, or diseases such as diabetes

• Makes chewing and swallowing more difficult, promotes tooth decay, and alters the sense of taste

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Leukoplakia

• White patches in the mouth• Often are precancerous and require prompt

medical attention• Can also be med s/e or thrush• Lesions on the posterior third or sides of the

tongue often are abnormal and should be brought to the attention of the physician

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Leukoplakia (cont.)

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A disease that is suspected to play a role in thromboembolic disorders, bacterial endocarditis, and myocardial infarction is:A. dental caries.B. halitosis.C. gingivitis.D. periodontal disease.

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Cancer

• Oral or pharyngeal cancer have poor prognosis• Early recognition and treatment before mets

to other tissues offer the best hope• Symptoms- include leukoplakia or

erythroleukoplakia, sores in the mouth that do not heal, oral bleeding, pain or difficulty swallowing, difficulty wearing dentures, swollen lymph nodes in the neck, earache

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Disorders Caused by Vitamin Deficiencies

• Certain deficiencies of riboflavin, niacin, and vitamin C can affect oral mucous membranes

• A smooth purplish sore tongue may be related to riboflavin deficiency

• Complaint of a burning sensation or soreness of the mouth may indicate niacin deficiency

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Superinfections

• Superinfections of the mouth are relatively common in older individuals who receive broad-spectrum antibiotic therapy for some other infection

• Antibiotics destroy the normal mouth flora and allow opportunist bacteria or yeast colonies to become established and grow

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Superinfections (cont.)

• A hairy tongue is the result of enlargement of the papillae on the tongue; this often follows antibiotic therapy

• Black or brown discoloration on the tongue may be caused by tobacco use or by a chromogenic (color-producing) bacterium

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Alcohol- and Tobacco-Related Problems

• Alcohol and tobacco, even in small amounts, can harm the mucous membranes

• Alcohol- chemically irritating and drying to the mucous membranes

• Tobacco, whether smoked, chewed, or taken as snuff, increases the risk for oral cancer

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Problems Caused by Neurologic Conditions

• Neuro conditions such as stroke, multiple sclerosis, or Parkinson’s disease decrease coordination and strength– difficult for the person to manipulate the

equipment needed for oral hygiene– Can be difficult to open mouth

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Problems Caused by Neurologic Conditions (cont.)

• severe arthritis may find equipment difficult to manipulate– May be difficult to open the mouth adequately for

good, thorough cleaning• medication for seizure or other neuro

disorders need to use special precautions– medications often cause gum problems

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Nursing Interventions for Impaired Oral Mucous Membranes

• Complete a thorough assessment of the oral mucous membranes

• Initiate referral to a dentist or dental hygienist• Provide oral hygiene

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Nursing Interventions for Impaired Oral Mucous Membranes (cont.)

• Promote adequate intake of nutrients and fluids

• Provide lozenges or topical analgesics as prescribed

• Communicate suspected oral side effects of medication therapy to the physician and dentist

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Dental care

• Access to dental care is often an issue for people with impaired mobility