Geriatric NCLEX Clinical Study Booklet · 10 cards
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Normal Aging Changes. Physiology Body Systems
Cardiac: ↓output, stiffer vessels → HTN risk Respiratory: ↓elasticity, ↓cough → infection risk Renal: ↓GFR → drugs accumulate GI: slowed motility → constipation Sensory & Skin
↓vision, hearing, taste, smell Thinner, less elastic skin → injury/pressure risk ↓thirst sensation → dehydration Key Points
Slower drug metabolism — adjust doses Higher fall & infection risk Atypical presentation (infection = confusion, not fever) NCLEX Tip Older adults often present atypically — a UTI or pneumonia may show up as new confusion rather than fever. Always investigate acute confusion.
Fall Prevention. Safety What is Fall Prevention?
Falls are a leading cause of injury and death in older adults. Usually multifactorial. What are the Causes / Risk Factors?
Weakness, gait/balance problems Polypharmacy (sedatives, antihypertensives) Vision impairment, orthostatic hypotension Environmental hazards Cognitive impairment What are the Symptoms?
History of falls Unsteady gait Dizziness Fear of falling How is it Diagnosed?
Fall-risk assessment (Morse scale) Gait / balance evaluation Medication review What is the Treatment?
Bed low & locked, call light in reach, non-skid footwear Clear pathways, lighting, grab bars Assistive devices; PT Review meds; treat orthostatic hypotension NCLEX Tip Fall prevention: bed low and locked, call light within reach, non-skid footwear, clear pathways, and review high-risk medications.
Polypharmacy. Medication What is Polypharmacy?
Use of multiple medications (often ≥5), common in older adults. Increases interactions, side effects, and errors. What are the Causes / Risk Factors?
Multiple chronic conditions Multiple prescribers OTC / supplement use Poor medication reconciliation What are the Symptoms?
Confusion, falls, sedation Drug interactions / side effects Nonadherence Duplicated therapies How is it Diagnosed?
Medication reconciliation Review against Beers Criteria What is the Treatment?
Reconcile & simplify the regimen One pharmacy; pill organizers Educate on each medication Monitor for adverse effects; 'start low, go slow' NCLEX Tip Use the Beers Criteria to spot potentially inappropriate medications in older adults. Reconcile meds and 'start low, go slow.'
Delirium vs Dementia. Cognition Delirium
ACUTE, sudden onset; fluctuates Reversible — has an underlying cause (infection, meds, dehydration, hypoxia) Impaired attention, disorganized thinking A medical emergency — find the cause Dementia
GRADUAL, progressive onset Chronic and irreversible Memory loss predominates Attention preserved until late Nursing Care
Delirium: identify & treat the cause (labs, meds, O₂) Dementia: safe environment, routine, reorientation Both: calm, familiar surroundings, safety NCLEX Tip Delirium is ACUTE and reversible — treat it as an emergency and find the cause (often infection, meds, or dehydration). Dementia is gradual and chronic.
Elder Abuse. Psychosocial What is Elder Abuse?
Harm or neglect of an older adult by a caregiver. Physical, emotional, financial, sexual, or neglect. What are the Causes / Risk Factors?
Caregiver stress / burnout Dependency, isolation Cognitive impairment Financial motives What are the Symptoms?
Unexplained injuries, bruises at various stages Poor hygiene, malnutrition, dehydration (neglect) Fear around the caregiver Sudden financial changes Inconsistent explanations How is it Diagnosed?
Careful assessment (interview alone) Document objectively What is the Treatment?
Ensure immediate safety MANDATORY reporting (Adult Protective Services) Document findings factually Interdisciplinary support NCLEX Tip Elder abuse is a mandatory report. Interview the older adult alone, document injuries objectively, and ensure their immediate safety.
Depression in Older Adults. Psychosocial What is Depression in Older Adults?
Depression is common but NOT a normal part of aging. Often underdiagnosed; can mimic dementia (pseudodementia). What are the Causes / Risk Factors?
Losses (spouse, independence, health) Chronic illness, pain Social isolation Medications What are the Symptoms?
Sadness, hopelessness Withdrawal, anhedonia Sleep / appetite changes Cognitive complaints (pseudodementia) Suicide risk (especially older men) How is it Diagnosed?
Geriatric Depression Scale Rule out medical causes What is the Treatment?
Antidepressants (SSRIs), therapy Social engagement Treat underlying conditions Assess suicide risk NCLEX Tip Depression is not normal aging. Older adults (especially men) have a high suicide risk — always assess for it.
Sensory Impairment. Physiology What is Sensory Impairment?
Age-related decline in vision, hearing, and other senses. Affects safety, communication, and quality of life. What are the Causes / Risk Factors?
Presbyopia, cataracts, glaucoma, macular degeneration Presbycusis (hearing loss) Neuropathy What are the Symptoms?
Difficulty seeing at night / reading Asking for repetition, social withdrawal Increased fall risk Isolation, depression How is it Diagnosed?
Vision & hearing screening Functional assessment What is the Treatment?
Ensure glasses / hearing aids are used & working Face the person, speak clearly (don't shout) Adequate lighting; reduce glare Safety adaptations NCLEX Tip When communicating with a hearing-impaired older adult, face them and speak clearly at a slightly lower pitch — don't shout.
Frailty / Sarcopenia. Physiology What is Frailty / Sarcopenia?
Age-related loss of muscle mass, strength, and reserve. Increases vulnerability to stressors. What are the Causes / Risk Factors?
Aging, inactivity Poor nutrition (low protein) Chronic illness Hormonal changes What are the Symptoms?
Weakness, slow gait Unintentional weight loss Exhaustion, low activity Frequent falls, poor recovery from illness How is it Diagnosed?
Frailty assessment Gait speed, grip strength Nutritional assessment What is the Treatment?
Resistance exercise, activity Adequate protein & nutrition Treat underlying conditions Fall prevention; PT NCLEX Tip Combat frailty with resistance exercise and adequate protein. Frail older adults recover poorly from illness — prevent complications.
Complications of Immobility. Safety What is Complications of Immobility?
Prolonged immobility affects every body system. Common and preventable in older adults. What are the Causes / Risk Factors?
Bed rest, illness, surgery Weakness, pain Cognitive impairment What are the Symptoms?
Pressure injuries DVT / PE Pneumonia, atelectasis Constipation, urinary stasis Muscle atrophy, contractures Orthostatic hypotension How is it Diagnosed?
Skin, respiratory, circulatory assessment What is the Treatment?
Reposition q2h; early mobilization Incentive spirometer, deep breathing ROM exercises; SCDs / VTE prophylaxis Hydration, fiber; skin care NCLEX Tip Immobility harms every system. Reposition every 2 hours, mobilize early, use incentive spirometry, and prevent VTE.
Palliative / End-of-Life Care. Care What is Palliative / End-of-Life Care?
Comfort-focused care for serious or terminal illness. Palliative = any stage; hospice = terminal (~6 months). What are the Causes / Risk Factors?
Advanced / terminal illness Focus shifts from cure to comfort What are the Symptoms?
Pain, dyspnea Anorexia, fatigue Anxiety, existential distress Approaching death: mottling, ↓intake, Cheyne-Stokes breathing How is it Diagnosed?
Symptom & goals-of-care assessment Advance directives review What is the Treatment?
Aggressive symptom / pain control (opioids appropriate) Honor advance directives & DNR Emotional / spiritual support; family Mouth care, positioning, presence NCLEX Tip In end-of-life care, prioritize comfort — pain and dyspnea control come first, and around-the-clock opioids are appropriate. Honor advance directives.
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