Vn057 gerontology 9
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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. Factors that Affect Sexuality of Older Adults. Normal Changes in Women.

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VN057 Gerontology 9

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Vn057 gerontology 9

VN057 Gerontology 9


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

Chapter 16

Sexuality and Aging


Factors that affect sexuality of older adults

Factors that Affect Sexuality of Older Adults


Normal changes in women

Normal Changes in Women

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


Changes in women

Changes in Women

  • The good

    • More relaxed about sexuality

      • Experience/assertiveness

      • No pregnancy worries

      • Less life stress


Changes in women cont

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


Erectile dysfunction in men

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


Illness and decreased sexual function

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


Illness and decreased sexual function cont

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…..


Illness and decreased sexual function cont1

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


Alcohol and medications

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


Loss of partner

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


Loss of partner cont

Loss of Partner (cont.)


Marriage and older adults

Marriage and Older Adults


Marriage

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


Caregivers and the sexuality of older adults

Caregivers and the Sexuality of Older Adults


Caregivers

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


Sexual health and sexual orientation

Sexual Health and Sexual Orientation


Sexual health

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


Sexual orientation

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


Privacy and personal rights of older adults

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


Touch and affection

Touch and Affection


Vn057 gerontology 9

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


Chapter 17

Chapter 17

Care of Aging Skin

and Mucous Membranes


Skin color

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


Dry skin

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


Assessing skin impairment

Assessing Skin Impairment


Dry scaly skin

Dry, Scaly Skin


Rashes and irritations

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 (Sarcoptesscabiei) that burrows under the skin


Scabies lesions

Scabies Lesions


Pigmentation

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


Tissue integrity

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


Pressure ulcers

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


Pressure ulcers cont

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


Risk factors for pressure ulcers

Risk Factors for Pressure Ulcers

  • Immobility

  • Inactivity

  • Incontinence

  • Malnutrition

  • Diminished sensation, decreased mental status

  • Impaired skin integrity


Braden scale for predicting pressure sore risk

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


Bony prominences and common pressure ulcer sites

Bony Prominences and Common Pressure Ulcer Sites


Pressure ulcers1

Pressure Ulcers


Vn057 gerontology 9

A common complaint in older adults that may be caused by dryness, irritation, or infection of the skin is:

  • decubitus.

  • bruising.

  • pruritus.

  • alopecia.


Amount distribution appearance and consistency of hair

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


Hair cont

Hair (cont.)

  • Sudden &excessive loss (alopecia) or breakage canindicate 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


Vn057 gerontology 9

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


Common foot problems

Common Foot Problems


Foot ulcers

Foot ulcers


Foot ulcers1

Foot ulcers


Nails

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


Nails1

nails


Other common foot problems

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


Nursing interventions for impaired skin integrity

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


Treatment options

Treatment Options

  • Treatment options for pressure ulcers are dependent on the stage


Vn057 gerontology 9

A superficial infection caused by a parasitic mite that burrows under the skin is:

  • lice.

  • scabies.

  • ringworm.

  • leukoplakia.


Objectives

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


Nursing process for impaired oral mucous membranes

Nursing Process for Impaired Oral Mucous Membranes


Dental caries

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


Periodontal disease

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 contact


Periodontal disease cont

Periodontal Disease (cont.)

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


Vn057 gerontology 9

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


Dentures

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


Dry mouth

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


Leukoplakia

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


Leukoplakia cont

Leukoplakia (cont.)


Vn057 gerontology 9

A disease that is suspected to play a role in thromboembolic disorders, bacterial endocarditis, and myocardial infarction is:

  • dental caries.

  • halitosis.

  • gingivitis.

  • periodontal disease.


Cancer

Cancer

  • Oral or pharyngeal cancer have poor prognosis

  • Early recognition and treatment before metsto 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


Disorders caused by vitamin deficiencies

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


Superinfections

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


Superinfections cont

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


Alcohol and tobacco related problems

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


Problems caused by neurologic conditions

Problems Caused by Neurologic Conditions

  • Neuroconditions 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


Problems caused by neurologic conditions cont

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 neurodisorders need to use special precautions

    • medications often cause gum problems


Nursing interventions for impaired oral mucous membranes

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


Nursing interventions for impaired oral mucous membranes cont

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


Dental care

Dental care

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


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