Introduction to Medical-Surgical Nursing, 6th ed.
11
Lesson Plans for
The Older Patient
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 11.1:
2. Determine the extent to which selected myths and stereotypes about older adults are factual.
4. Explain the importance of assessing activities of daily living and instrumental activities of daily living.
5. Explain why drug dosage adjustments may be needed for older persons.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to the special needs of the older patient and the role of
the nurse in attending to those needs.
• Special attention is placed on the myths and stereotypes of older adults as they contrast with statistical
trends for this population.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Attributes and Resources
2 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Individuals living in the United States who are 65 years old today and in reasonably good health will
likely live to be _____ years old.
a) 70
b) 75
c) 85
d) 95
2) The process of growing older and more mature is referred to as __________.
a) aging
b) declining
c) adapting
d) functioning
3) The professional nursing responsibilities associated with gerontological nursing include __________.
a) promoting universal health care for those 65 and older
b) encouraging elder care to be moved to assisted living facilities
c) promoting healthy living behaviors for the older adult
d) decreasing dependence on prescription drugs
4) The percentage of older adults living in long-term care facilities is __________.
a) 6%
b) 12%
c) 18%
d) 25%
5) The “Error Theory” of aging is based on the belief a person ages due to __________.
a) genetic predisposition
b) accumulation of damage over time
c) decreased exposure to ultraviolet rays
d) excess of vitamins and nutrients
6) Age-related short-term memory problems may be related to __________.
a) lack of oxygen as the brain ages
b) too much long-term memory
c) increased neuron sensitivity
d) gradual brain swelling related to aging
7) Age-related decreased respiratory function may be attributed to __________.
a) scoliosis
b) kyphosis
c) arthrodesis
d) avascular necrosis
8) The elevated laboratory value that indicates age-related impaired renal function is __________.
a) cardiac enzymes
b) glucose
c) electrolytes
d) blood urea nitrogen
9) An appropriate way to stimulate cognitive function and a sense of life’s purpose in an older adult is
__________.
a) daily hygiene
b) a brisk walk
c) volunteer activity
d) antidepressant medication
10) Medication effectiveness may be altered in the older adult due to decreased __________.
a) urine concentration
b) gastric motility
c) thirst sensation
d) olfactory function
______________________________________________________________ Chapter 11 The Older Patient 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: A nurse is assisting in a health screening at a local senior center. The nurse is reviewing heart
and blood pressure medications with a 73-year-old man. When the nurse asks about urinary elimination,
the patient denies having any problems, but adds he only voids two to three times in a 24–hour period.
Should the nurse note this on the screening assessment? Why? Why not?
Answer: Yes. The number of nephrons is reduced by one-half to possibly two-thirds by the seventh
Question: An 84-year–old with a history of asthma and chronic bronchitis continues to complain of
weakness, fatigue, and a poor appetite after being discharged from the hospital 3 months ago for
pneumonia. He continues to take medication for diabetes mellitus and hypertension and complains of
shortness of breath. His lung sounds are clear and the chest x-ray is negative. How can the nurse assist
the patient with his continued recovery?
4 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Textbook Objectives Covered
2. Determine the extent to which selected myths and stereotypes about older adults are factual.
3. Describe biologic and physiologic factors associated with aging.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the care and treatment of the older patient, including:
• The role of the nurse
• The current state of aging as revealed in statistical trends as compared to the myths and
stereotypes surrounding this period
changes in physiologic makeup
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• ageism (p. 138)
• aging (p. 137)
• cataract (p. 144)
• conduction deafness (p. 143)
• presbycusis (p. 143)
• presbyopia (p. 144)
• sensorineural deafness
(p. 143)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 137-138)
REVIEW
• Figure 11-1: Regular exercise in an important part of health promotion (p. 143)
• Box 11-2: Content areas of the OARS multidimensional functional assessment (p. 147)
• Box 11-3: SPICES assessment tool (p. 147)
ANSWER – Text
ANSWER – Study Guide
• Part IIB: 18 (p. 55)
______________________________________________________________ Chapter 11 The Older Patient 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
2
READ – Textbook (pp. 138-140)
REVIEW
• Figure 11-2: Most older adults are active and independent (p. 145)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4, 5 (p. 150)
ANSWER – Study Guide
3
READ – Textbook (pp. 140-145)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2, 3, 6 (pp. 149-150)
ANSWER – Study Guide
50-Minute Lesson Plan
Lecture Outline 20 minutes
1
Slide 1
Chapter 11
The Older Patient
Slide 2
• Age identification consists of much more than just recognition of chronologic age.
Definitions of Old Age
• Most definitions = having lived a long time
• Aging: process of growing older or more mature
• Aging is an ongoing developmental process that begins at conception and ends in death
TALKING POINTS:
• What age is commonly used to indicate the onset of old age?
Slide 3
Gerontology
• The study of aging
TALKING POINTS:
• Gerontology can be dated to the early 1950s.
• What areas are included in gerontology?
Geriatrics
• The biomedical science of old age and the application of knowledge related to the
TALKING POINTS:
• The term geriatrics was coined in recognition of the similarity to the field of pediatrics.
• What disciplines are included in the field of geriatrics?
6 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 5
Roles of the Gerontological Nurse
• Typically refers to professional level nurses with advanced degrees
• Registered nurses who demonstrate appropriate knowledge and experience can seek
gerontological nurse credentialing
TALKING POINTS:
• In 1989, 12% of the U.S. population was age 65 and older.
Slide 6
Gerontological Nurse
• Professional nurses and advanced-level practitioners, clinical specialists, and nurses
holding national certification
• Incorporates basic nursing methods and specialized knowledge about the aged
2
Slide 7
Ageism
• Systematic stereotyping and discrimination against people because of their age
• Creates assumptions without assessing the individual
• Allows those who practice ageism to distance themselves from their own aging
• Influences the behavior of its victims
TALKING POINTS:
• Nurses must be knowledgeable about aging to avoid generalizing about older adults.
• Who introduced the concept of ageism?
3
Biologic and Physiologic Factors in Aging
• Despite intense interest in longevity by so many cultures, scientists do not agree on
precisely why or how humans age
TALKING POINTS:
• Medical science has made great strides in conquering many ills, but little has been
Slide 9
Theories of Aging
• Theories of aging range from the concept of purely genetic control of aging to
environmental assaults that result in death
______________________________________________________________ Chapter 11 The Older Patient 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 10
Error Theories
• Based on the belief that the rate of aging is directly related to the organism’s rate of living
and that external events cause damage to the organism’s cells
• The damage from all causes accumulates over time, resulting in cellular, molecular, and
organ malfunction or errors
TALKING POINTS:
• What are some examples of the error theory?
Programming Theories
TALKING POINTS:
• Theories about aging continue to evolve, and no single theory is entirely explanatory or
universally accepted.
• What are some examples of programming theories?
Slide 12
Nervous System
• Essential to know that in the absence of disease, most aged people remain alert, with
functional intellectual capability, sound judgment, creativity
• Only modest impairments in memory and learning after age 70 in most people who are
relatively free from major disease
TALKING POINTS:
• Brain size is generally thought to decrease with age, although evidence for this belief is
not conclusive.
• When does the loss of neurons begin?
Slide 13
Nervous System (cont.)
• Short-term memory loss frequently a concern of the aged; long-term memory may remain
intact
• Stimulus input into the neurons; dependent on adequate tissue oxygenation
TALKING POINTS:
• The aging brain may be considered to be in a chronic hypoxic state.
• What are some examples of normal memory changes?
8 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 14
Nervous System (cont.)
• Strategies to cope with memory problems
• Mnemonics
• Stringing together known and unknown information
• Rehearsal memory training
• Repetition
TALKING POINTS:
• Many diseases and medications might alter sensory perception.
• How may stressors affect the older adult’s nervous system?
Slide 15
Respiratory System
• Forced vital capacity, vital capacity, and maximum breathing capacity thought to decrease
progressively with aging. Related to:
• Atrophy/weakening of respiratory muscles
Slide 16
Respiratory System (cont.)
• Loss of elastic tissue surrounding alveoli
• Alterations in pulmonary circulation result in decreased diffusion across the alveolar–
TALKING POINTS:
• What would you expect a 70-year-old patient’s arterial oxygen values to be?
• Changes in the capillaries affect pulmonary diffusion so that gas exchange is impaired.
Slide 17
Respiratory System (cont.)
• Exertional dyspnea
• Shortness of breath with exertion
• A frequent complaint with the older adult
• Ability to perform prolonged strenuous work decreases with aging
TALKING POINTS:
• The ability of the older adult to maintain adequate oxygenation is not seriously impaired
under conditions of health and moderate activity.
______________________________________________________________ Chapter 11 The Older Patient 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 18
Cardiovascular System
• Resistance to blood flow in many organs increases as people age
• Aging results in the development of whitish patches, fibrosis, and sclerosis in the
endocardium
• The heart becomes more rigid and myocardial contractility is compromised
TALKING POINTS:
• How much may coronary blood flow in the older adult decrease?
Slide 19
Cardiovascular System (cont.)
• Coronary blood flow may be reduced by as much as 35% because of changes in the
vessels
• Valvular rigidity and incomplete closure of aortic and pulmonic valves may result in
murmurs
• Heart cells have a decreased capacity to use oxygen, which may help explain the aged
person’s reduced tolerance for physical work
• Pulse increases and the pulse pressure widens
TALKING POINTS:
• At what age does thickening and calcification of the intimal layer of the vessels occur?
• For many people, systolic blood pressure increases to approximately 150 mm Hg and
Slide 20
Cardiovascular System (cont.)
• Decrease in resting cardiac output
• Amount of blood pumped each minute
• Between ages 25 and 65, resting cardiac output falls 30% to 40%
• Reduced cardiac output reflects a decreased heart rate and decreased stroke volume
• Cerebral blood flow maintained, but other body systems, such as the liver and
kidneys, receive a diminished blood supply
because of reduced functional requirements.
Slide 21
Renal System
• Decreases in filtration rate, plasma flow rate, and tubular reabsorption and secretion
• Blood urea nitrogen tends to increase
• Ability to concentrate or dilute urine is diminished
• Total body water decreases by half
• How is the acid-base balance affected by aging?
10 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 22
Renal System (cont.)
• Bladder capacity may be reduced by half
• Response to the stretch receptors in the bladder wall that signal the need to void may be
delayed until the pressure is high and the bladder almost filled to capacity
• Lax muscle tone may lead to incomplete emptying of the bladder
• Residual volume may cause subsequent urinary tract infections
TALKING POINTS:
• What causes urge incontinence?
Slide 23
Renal System (cont.)
• Incontinence
• May appear as a symptom of upper or lower urinary tract dysfunction
• Conservative behavioral treatment is recommended as the first level of intervention
TALKING POINTS:
• What is the best way to instruct the patient how to perform Kegel exercises?
Slide 24
• Roughness
Integumentary System
• Skin changes can be the most distressing to the older person because they are so visible
• Skin changes include:
• Dryness
• Loss of elasticity
• Wrinkles
• Uneven pigmentation and brown spots
TALKING POINTS:
• What is one of the first signs of aging?
Slide 25
Integumentary System (cont.)
• Wrinkles
• Occur when the deep layer of the skin loses moisture and elasticity
• Tiny creases and folds are formed
• Extent and timing determined by genetics and sun exposure
TALKING POINTS:
• Skin that is exposed to the sun most often, such as the face, hands, and back of the neck,
______________________________________________________________ Chapter 11 The Older Patient 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 26
Integumentary System (cont.)
• Itching
• Related to loss of oils in the skin
Slide 27
Integumentary System (cont.)
• Hair loss, hair thinning, and color changes
• Men tend to grow bald, and women experience thinning of the hair on the head and
genitalia
• The number of facial and nasal hairs may increase
TALKING POINTS:
• Routine visits to a podiatrist are encouraged for nail trimming and care of corns and
Slide 28
Gastrointestinal System
• Oral cavity
• Deterioration in the teeth and a decrease in the functional taste buds
• Decrease in saliva secretion
• Related to medications, inadequate hydration, and illness states rather than
normal aging change
• Saliva tends to become more alkaline as the salivary glands secrete less ptyalin
and amylase
Gastrointestinal System (cont.)
• Muscles associated with chewing weaken, peristalsis is slower, and the risk of formation
of intestinal diverticula increases
TALKING POINTS:
• What problems may the older adult be at risk for due to changes in the gastrointestinal
system?
12 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 30
Gastrointestinal System (cont.)
• Constipation
• Frequent gastrointestinal complaint
• From decreased intestinal motility, altered bacteria flora, a diet low in bulk and
TALKING POINTS:
• What gastrointestinal symptoms may suggest possible illness?
Slide 31
Musculoskeletal System
• Arthritis
• The most prevalent chronic disease in men
• More severe in women
• Leading cause of disability
• Osteoarthritis
• Most common form of arthritis
TALKING POINTS:
• What is the primary risk factor for arthritis?
Slide 32
Musculoskeletal System (cont.)
• Kyphosis
• Curvature of the thoracic spine that gives rise to the bent-over appearance of some
older adults
• Teach benefits of weight-bearing exercises
TALKING POINTS:
• What observations should the nurse make when assessing the older adult for
musculoskeletal system disorders?
______________________________________________________________ Chapter 11 The Older Patient 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 33
Sensory System
• Presbycusis
• Hearing loss associated with age
• 25% of adults older than age 69, and half of adults older than age 85 are hearing–
impaired
• Conduction deafness
TALKING POINTS:
• Sensory changes in the older adult place them at risk for injury and weaken self-
confidence.
• What sounds are difficult for many older adults to hear?
Slide 34
Sensory System (cont.)
• Macular degeneration
• Affects the macula, the part of the eye responsible for sharp central vision
• Cataract
• Clouding or opacity of the normal transparent lens within the eye
• Surgical removal of the clouded lens
TALKING POINTS:
• Failing eyesight is not an inevitable consequence of age, but several eye diseases are
Slide 35
Sensory System (cont.)
• Presbyopia
• Affects the shape of the lens
• Reading and other close work become difficult
• Glaucoma
TALKING POINTS:
• The shape of the lens is controlled by muscles in the eye; with age, the lens becomes
more rigid and is less able to change shape.
• How can presbyopia be corrected?
14 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Slide 36
Sensory System (cont.)
• Chemosensory disorders
• Involve taste and smell
• Causes: nasal obstruction, allergies, certain drugs
• Some scientists believe that the decline in smell is due to a decrease in olfactory
TALKING POINTS:
• Most chemosensory disorders occur after age 60 and involve the ability to differentiate
scents.
• The inability to smell smoke, poisons, or other noxious odors endangers the lives of many
older people.
• When does the loss of taste buds begin?
Slide 37
Question 1
• Laurie Gunter and Carmen Estes describe gerontological nursing as a health service that
incorporates basic nursing methods and specialized knowledge about the aged to
establish conditions within the patient and within the environment all of the following
EXCEPT:
A. Decrease healthy behaviors in the aged
B. Minimize and compensate for health-related losses and impairments of aging
C. Provide comfort and sustenance through the distressing and debilitating events of
aging
D. Facilitate the diagnosis, care, and treatment of disease in the aged
TALKING POINTS:
Slide 38
Question 2
• Which of the following statements about the aging nervous system is true?
A. Brain size generally is thought to increase with age.
B. Aging changes in the nervous system include decreased conduction speed and
increased activity of the enzymes associated with synaptic transmission.
C. Extreme impairments in memory and learning are observed in most people over age
70.
D. Functional ability may not be affected significantly because reserve cells are able to
compensate.
TALKING POINTS: