NURS 404_Thru Midterm

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1

What's the nurse's primary challenge in gerontological nursing practice?

The nurse’s primary challenge is to identify and use the strengths of older adults and assist them to maximize their independence, minimize disability, and where appropriate, achieve a peaceful death

2

-Environmental and biopsychosocial consequences impact functioning

-Nursing’s role is to minimize age-associated disability in order to enhance safety and quality of living

Functional consequences theory of wellness

3

-Failure to thrive results from a discord between the individual and his or her environment or relationships.

-Nurses identify and modify factors that contribute to disharmony among these elements.

Theory of thriving

4

Process of systematically stereotyping, prejudice, or discrimination for or against an age group

Ageism

5

Beliefs/attitudes based on a stereotype

Prejudice

6

Infection in the older adult:

Oftentimes there'll be an absence of __1__; other S/S include a change in __2__, weight loss & decline in __3__

You may even see new onset __4__ or __5__

1. Fever

2. LOC/mental status

3. Appetite

4. Falls

5. Incontinence

7

Stereotype: Older adults are frail, feeble, capable of making limited contribution

Fact: 38 million aged 55+ contribute through volunteerism equal to 20 million full-time employees

Fact: One out of five contributes a sizable portion to children’s and grandkids income

8

Older adults get _____ aggressive treatments

Less

9

Functional assessment tool:

Awards 1 point (if independent) or 0 points (with supervision or assistance) for each of 6-listed ADLs on this tool, to include:

Bathing

Dressing

Toileting

Transferring

Continence

Feeding

Katz Index of Independence in ADLs

6 = Very independent

0 = Very dependent

10

Most socially condoned & institutionalized form of prejudice in the U.S.

Ageism

11

These characteristics are associated with what's known as the "Greatest Generation"

Born 1925-1944

Older adults now, some "oldest old"

Prefer formal forms of address

Like to know provider credentials

Looks to system to direct care

May prefer face-to-face vs. using technology (i.e. kiosks)

12

Signs that an elder is experiencing psychological abuse:

Oftentimes you'll see the display of __1__ behavior & poor _____ 2 _____, along with these 3) psych manifestations

1. Infantile

2. Eye contact

3. Depression, agitation, withdrawal

13

52.3% of today's elderly are "young old", referring to this age range

65-74

14

32.2% of today's elderly are "middle old", referring to this age range

75-84

15

12.3% of today's elderly are "oldest old", referring to this age range

85+

16

Fastest growing sector of our population

Between now & 2050, size will double

Oldest old group (85+)

17

Race/ethnicity trends:

_____ populations over 65 will decline, whereas _____ populations over 65 will nearly triple

White, hispanic

18

In the older populations, death often results from this

Chronic disease

19

The top chronic diseases affecting older populations include:

HTN

Arthritis

Heart disease

Cancer

Diabetes

20

The belief or attitude that one’s own cultural view is the only correct view

Ethnocentrism

21

While cultural competence can help to understand the health care needs of any patient, some issues are more sensitive in creating trust and a communication bond between the patient and provider. Which of the following assessment domains most benefit from special understanding in assessing culturally diverse elders who are not acculturated to American core values?

a) Physical exam, health, and social history

b) End-of-life preferences, cognitive, affective status

c) Functional status, and spirituality

d) Home, and living situation

b) End-of-life preferences, cognitive, affective status

22

Protective factors r/t successful aging

No smoking • Moderate drinking • Regular exercise • Moderate weight • Education • Low blood pressure • Stable marriage/partnership; strong relationships • Mature defenses • Resilience; sense of optimism/hope

23

Highly educated, well informed, demanding consumers

Baby Boomers (entering over 65 age group)

24

This particular population of elders will account for ~30% of the older population in the next two decades; ~40% in next four

Minority (diversity increases)

25

A yearly screen for this should accompany the patient with HTN & other risk factors

Diabetes

26

HT/WT, vision/hearing, BP measurements should be screened at least this often

Yearly

27

According to the CDC, Older adults need at least how much aerobic & muscle activity each week?

2.5 hrs moderate-intensity aerobic activity Q week

Muscle-strengthening activities on 2+ days/week

28

Single most preventable risk factor for disease and death

Smoking

29

5Rs-to improve motivation to quit smoking

--Relevance - why is quitting important personally

– Risks - What are negatives acute, long term

– Rewards - what are potential benefits of stopping?

– Roadblocks - Barriers or impediments

– Repetition - at each clinical encounter/visit

30

Leading cause of fatal injury older adults to age 75

MVA

31

1. This scale can be used to monitor the healing process of a pressure ulcer

2. It can total up to 17 points, and the _____ the point value, the more healed the ulcer is

1. Pressure Ulcer Scale for Healing (PUSH)

2. Lower (i.e. 0 = very well healed; 17 = very poorly healed)

32

3rd leading cause of US cancer deaths

USPSTF recommends screening for colorectal cancer in adults, beginning at age __ years and continuing until age __ years

50, 75

33

Breast CA screening:

USPSTF recommends every other year in women __-__

50-74

34

USPSTF recommends against routinely screening women older than age 65 for _____ _____ if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk

Cervical cancer

35

A score of __ or more signifies significant depressive S/S on the Geriatric Depression Scale on the 30-item tool, whereas a score of __ or more on the 15 item GDS is cause for further work-up

10, 5

36

Strengths: valid, reliable, 5 – 10 minutes, need little training, can be administered by lay person

Limitations: relies heavily on verbal response, reading and writing • Cultural, educational/racial bias, low English proficiency, advanced age • Communication and sensory disorders • Does not assess mood, insight, remote memory, perceptual disturbances

Folstein Mini-Mental Status Examination (MMSE)

37

“Remember these 3 words: apple, table, penny” • (Back to #1 until able to repeat all 3 items) • “Draw a clock face” • “Put on the numbers” • “Put on hands to make the time be ELEVEN-TEN” • “What were the 3 items?”

Mini-Cog (0-2 positive screen, 3-5 negative)

38

Lawton Instrumental Activities of Daily Living (IADL) include:

• Ability to use telephone • Shopping • Food preparation • Housekeeping • Laundry • Mode of transportation • Responsibility for own medications • Ability to handle finances

39

Physical Performance Measures tests include:

Timed Get Up & Go Test (TUGT)

Gait speed

Physical Performance Test

6 minute walk

40

How does the nurse administer the Timed Get Up and Go Test (TUGT)?

Rise from chair

Walk 10'

Turn around & walk back

Sit in chair

*Any undue slowness, hesitancy, abnormal movements/staggering can be indicative of a risk for falls

41

Geriatric Assessment Tool that assesses sleep, problems with eating or feeding, incontinence, confusion, evidence of falls, skin breakdown

SPICES

42

Geriatric Assessment Tool that assesses ADLs, IADLs, cognitive status

Hospital Admission Risk Profile (HARP)

43

T/F:

Age in years correlates well with biological age

F

*Age in years correlates well with CHRONOLOGICAL AGE

44

The top 5 chronic diseases affecting older populations include:

HTN

Arthritis

Heart disease

Cancer

Diabetes

45

Older adults experience delays in ability to perform sensory and motor tasks related to:

a) A decrease in neurons and neurotransmitters

b) Decreased ligament and tendon strength

c) Changes in synaptic transmission

d) All of the above

d) All of the above

46

Normal aging-related nervous system changes include which of the following?

(check all that apply)

Balance

Attention

Long-term memory

Motor skills

Cognitive processing

Deep tendon reflexes

Balance

Motor skills

Cognitive processing

Deep tendon reflexes

47

Which of the following statements about the sensory system is correct?

a) Aging results in decreased ability to perceive pain

b) The loss of ability to hear high frequency sounds occurs in aging

c) The lens of the eye becomes more pliable with increased age, resulting in presbyopia

d) The aging eye requires less time to accommodate to changes in light

b) The loss of ability to hear high frequency sounds occurs in aging

48

Which of the following best describes normal cardiovascular changes in the older adult?

a) Increased arterial wall elasticity

b) Increased peripheral pulses

c) Decreased maximal heart rate and cardiac output with exercise

d) Decreased heart rate and cardiac output at rest

c) Decreased maximal heart rate and cardiac output with exercise

49

Which of the following best describe normal gastrointestinal changes in the older adult?

a) Increased incidence of diarrhea

b) Decreased risk of GERD

c) Delayed gastric emptying

d) Increased drug metabolism

c) Delayed gastric emptying

50

Quality Care and Safety Measures includes multiple goals, including:

Improve individual patient care

Improve population health

Reduce (unnecessary) costs of care

51

Measures quality for nursing homes

MDS data

52

Measures quality for home health

OASIS data

53

Disease or state caused by hospital setting

Iatrogenic

54

CMS will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves

Hospital Value-based Purchasing Program

55

Consequences of falls include:

FX

TBI

Loss of independence

Decreased QoL

Death

56

Fall prevention should start by addressing _____ factors

Modifiable factors

57

Use of these types of drugs in geriatric patients results in a huge risk for falls

Long-acting benzos

Psychotropics

Anticholinergics (i.e. Oxybutynin for OAB)

Antidepressants

*Mild risk w/diuretics, class I antiarrhythmics, & digoxin

58

To prevent falls, the CDC has these recommendations

Exercise

Review meds

Annual vision check

Shoe type

Reduce home hazards

59

What OTC meds may increase a geriatric patient's risk for falls?

Those with sedating S/E (i.e. Tylenol PM or diphenhydramine-containing product)

60

The US Preventive Services Task Force highlights this vitamin to be an important part in the risk for falls cascade related to its effect on bone & muscle function

Vitamin D (supplementation)

61

Patients with hearing aids should remove them before doing what?

Before applying cosmetics (cologne, perfume, hair spray, hair dryer, etc)

62

Important interventions in preventing falls

Staff education

Meds review

Environmental adaptation

Vitamin D

+/- Exercise

+/- Dietary counseling

63

This tests functional mobility

Patient starts in chair, then stands from chair & walks to line that's 10 feet away

Turns around and returns to chair, sitting down

*Assess gait, balance, use of assistive devices

Timed up and go test (TUG)

64

What's the first thing you want to do when a patient falls?

Assess patient!

*Then, let someone know, monitor/reassess & document fall

65

Effective communication w/older adults includes:

  • Position yourself in front w/light on your face, introduce yourself
  • Expect to take more time
  • Speak clearly, slowly, and at a low-frequency pitch; don’t hide your mouth
  • Use multiple channels – gestures, diagrams, take- home materials
  • Keep it simple (yes/no); avoid jargon, acronyms
  • Stop to ask for questions and feedback; allow time to think and respond
66

Yellowing of the lens over time can occur with aging. Because of this, we should avoid teaching our patients how & when to take their meds using this method

Take the green pill in the morning & the yellow pill in the evening

*Color distortion may occur, leading to wrong med or noncompliance w/therapy

67

To prevent falls, the CDC has these recommendations

ERASR

Exercise

Review meds

Annual vision check

Shoe type

Reduce home hazards

68

Why are vaccinations less protective in the older patient?

Antibody response to vaccine is slower & weaker = less protection production

69

What S/S of infection may be present in the older patient?

Absence of fever

Change in mental status/decline in function

Weight loss/decline in appetite

New onset of falls or incontinence

*Difficulty detecting can lead to delayed TX

70

Due to an even greater risk for CAUTI in the older adult (risk increases 5% each hospital day), this train of thought should apply to using indwelling catheters

Avoid or D/C early

71

On the Norton Scale, generally score of __ or less indicates risk for pressure ulcer development

14 or less

*Less predictive than Braden

72

Skin tear categories:

1. Skin tear w/out tissue loss

2. Skin tear w/complete tissue loss (epidermal flap absent)

3. Skin tear w/partial tissue loss

1. Category I

2. Category III

3. Category II

73

In order to prevent pressure ulcer development, the HOB should be in what position?

30 degrees or less

*Turn & avoid positioning on trochanter

74

Methods to avoid skin tears include:

Wear long sleeves/pants

Skin moisturizing 2x/day

Soapless bathing products

Use paper tape or non-tape options to secure dressings

75

Why are older adults at a disadvantage r/t usability & accessibility regarding technology?

Designers of software/hardware technologies fail to consider them as a potential user group

76

T/F:

Older adults aren't receptive to technology

False (they are receptive to technology)

77

This age group is behind all other groups r/t computer ownership & internet use

Older adults (65+)

78

Of older adult groups, this group is most likely to have a computer & use the internet

"Young old" (65-69)

79

Cell phones are more likely to work than a land line following what?

A disaster (older adults should have more access to them)

*Older adults are especially lacking in smartphone ownership, limiting access to useful mobile applications

80

Extent to which patients follow instructions they're given for prescribed TX

50% of older adults have difficulty with this

Adherence

81

Some practical issues older adults have with using medications

ID medication

Opening package (dexterity)

Adjusting dosage (i.e. splitting/breaking pill)

Overall incorrect usage

82

These medications can actually emit a signal once they encounter stomach acid that is recorded and transmitted by a tracker on the abdomen, confirming the older adult took the medication

Certain ones can also track BP at different intervals, too

Digital medications (tracker enclosed)

83

What are some reasons that an older adult would want to live in a "smart home"?

Prolonging independence

Increased safety

84

Why do older adults who use hearing aids need to keep their ears clean?

More cerumen production as you age (can block/disrupt hearing aid)

85

Involves the VULNERABLE older adult & a "trusted other" with a duty of care

Caregiving Dyad

*May be domestic or institutional

86

Elder mistreatment is both a _____ and _____ process

Active & passive

*Acts or failure to act that lead to mistreatment of elders

87

Serious issues that aren't considered elder mistreatment

Abuse of a non-vulnerable older adult (i.e. assault of older woman by grandchild)

Stranger crimes (attack on older adult at bus stop, financial scams)

Resident-on-Resident Aggression

Self-neglect (older adult w/decision-making capacity decide not to take care of oneself)

88

Behavior of older adult that threatens his/her own health & safety

Self-neglect

*Increases risk of developing into elder mistreatment

89

These 3 components comprise elder mistreatment

Older adult

Vulnerability

Trust relationship

90

Many people think of physical abuse when hearing the phrase "elder mistreatment", but these elements also qualify as elder mistreatment

Financial

Neglect

Emotional

Sexual abuse

91

Why do so many older adults that are victims of elder mistreatment not report it?

Impaired cognition/physical function

Intentionally isolated by abuser

Shame, embarrassment, guilt, self-blame

Fear of reprisal

Pressure from family members

Fear of losing home, independence

Cultural mores

92

This population of older adults are at a heightened risk of abuse and/or neglect

Residents

93

-Results from a discord between the individual and his or her environment or relationships.

-Nurses identify and modify factors that contribute to disharmony among these elements.

Theory of thriving

94

Why do so many mandated reporters (i.e. MD, RN) not report EM?

Professional orientation

Knowledge/education

Assessment

Interpretation

Systems

95

Risk factors for Domestic EM: Victim Characteristics

Low social support

Poor health

Dependence on others for care (impaired physical/cognitive function)

Previous traumatic event

96

Risk factors for Domestic EM: Abuser Characteristics

Financial or housing dependence of adult children

Tend to be deviant (HX of violence or anti-social)

May be disabled (substance abuse or mental illness)

Tend to be poorly socially integrated (i.e. unemployed)

Abusive partners or family members

97

Physical neglect of the older adult involves:

Failure to provide basic necessities, physical aids (hearing aids, dentures, glasses, wheelchair), and other resources needed for the vulnerable adult's safety

98

Signs of possible physical neglect of the older adult

Pressure ulcers

Repeated falls

Malnutrition

Dehydration

Poor hygiene/soiled clothing

99

How could a lab finding suggest physical abuse of the older adult?

Values consistent with over- or under-medicating

100

What injury HX may suggest a pattern of possible physical abuse in-line with elder mistreatment?

Repeated, unexplained injuries

Injuries not consistent with story

Refusal to go to the same ED for repeated injuries

Burns from household goods (iron, cigarettes, curling irons)

101

Most large bruises that occur accidentally in older adults are observed where?

Extremities

*Very rare for an accidental bruise to be on the neck, ears, genitalia, buttocks, or soles of the feet

102

Older adults are significantly more likely to know how a bruise happened if it is on the _____

Trunk

103

Features of psychological neglect

Isolating older adult, restricting contact

Silent treatment

Failure to provide companionship

Treating elder as a child

104

Signs that an elder is experiencing psychological abuse

Depression

Agitation

Infantile behavior

Withdrawal/isolation

Poor eye contact

105

When conducting an interview with an older adult and his/her caregiver, what development will lead you to having concern about the possibility of psychological abuse?

Caregiver speaks for the patient repeatedly

*May want to figure out a way to separate the two in order to speak with the older adult alone

106

Psychological abuse includes:

Berating language

Harassment or intimidation

Threats of punishment or deprivation (i.e. nursing home threat)

Treating like a child or isolating from friends/family/activities

107

What signs on an elder client may represent possible sexual abuse?

Unexplained vaginal/anal bleeding

Torn/bloody underwear or absorbent pads

Bruised breasts

Unexplained STDs or other genital infections

108

A violation of personal rights has occurred when the abuser denies the older adult the right to:

Privacy

Make decisions regarding healthcare or personal matters

Forcible eviction and/or placement in a nursing home

109

ž“…leaving a child or other dependent person without the means or ability to obtain one or more of the basic necessities of life.”

Abandonment

110

—The denial or deprivation, by those responsible for the care, custody, and control of the older adult, of medical or surgical treatment or intervention which is necessary to remedy or ameliorate a medical condition which is life threatening or causes injury.

Medical Neglect

111

These are examples of medical neglect

Ignoring special diet or treatment

Not calling MD when necessary

Failure to provide meds or durable medical equipment

Lack of awareness r/t effects of meds

Not taking action on medical problems

112

Signs of institutional EM

Unexplained bruising/injuries

Repeated UTIs/infections

Poor hygiene

Weight loss, lack of interest in meals

Recurrent/worsening pressure ulcers

New onset depression, agitation, sleep problems

113

Interventions to use when any type of abuse is suspected in an older adult

Meticulous documentation (including photodocumentation)

Effective & safe interviewing

Assessment of danger level (safety plan, need for immediate hospitalization)

Mandatory reporting

Multidisciplinary Teams (MDTs)

F/U

114

What are some healthcare-related age-biases seen vs. older adults?

Get less aggressive treatments

Not seen as candidates for health promotion programs

Often excluded from health studies

115

USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they've had:

Adequate recent screening

Normal paps

Not high risk

116

What is involved in successful aging?

Active engagement w/life

High functional levels

Low probability of disease & disability

117

Successful aging is __1__, and is based on __2__ & __3__

1. Individual

2. Values

3. Experience

118

Primary preventive screening in older adults to promote health include:

Annual HT/WT

Annual BP

Annual diabetes screening (esp. those w/HTN or other risks)

Lipid screening (unclear interval)

119

Older adults & immunizations:

Should be given annually (from youth until death)

Influenza

120

Older adults & immunizations:

1-time dose should be substituted for booster

Then booster should be given Q 10 years

Tdap

121

Older adults & immunizations:

Should be given once after age 60

Zoster

122

Older adults & immunizations:

1 or 2 doses should be given prior to age 60 - none afterwards

MMR

123

Older adults & immunizations:

This should be given twice over the course of an adult's life

Varicella

124

Second-tier prevention activities to promote health in older adults include:

Annual hearing/vision screening

Annual osteoporosis screening in women 65+

Cancer/depression/cognition (dementia) screening

125

1. In what age range should women receive a mammogram?

2. How often?

1. 50-74

2. Every other year

126

A sensitive, valid and reliable 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment.[1] It is commonly used in medicine and allied health to screen for dementia. It is also used to estimate the severity and progression of cognitive impairment and to follow the course of cognitive changes in an individual over time; thus making it an effective way to document an individual's response to treatment.

Mini Mental Status Examination (MMSE), or Folstein test

127

What are the "5 R's" to improve motivation to quit (i.e. smoking)?

Relevance (why it's important)

Risks (negative short - and long-term consequences)

Rewards

Roadblocks

Repetition (at each clinical encounter/visit)

128

Functional assessment tool:

Awards 1 point (if independent) or 0 points (with supervision or assistance) for each of 6-listed ADLs on this tool, to include:

Bathing

Dressing

Toileting

Transferring

Continence

Feeding

Katz Index of Independence in ADLs

129

Lawton Instrumental Activities of Daily Living (IADL) include:

Using phone

Shopping

Food prep

Housekeeping/laundry

Mode of transportation

Responsibility for own meds

Ability to handle finances

130

S/S of caregiver stress may include:

  • Anxiety, depression, irritability
  • Feeling tired and run down
  • Difficulty sleeping
  • Overreacting to minor nuisances
  • New or worsening health problems
  • Trouble concentrating
  • Feeling increasingly resentful
  • Drinking, smoking, or eating more
  • Neglecting responsibilities
  • Cutting back on leisure activities
131

Components to look at when performing a social assessment include:

Social support (family, friends, neighbors, church)

Living arrangements

Resources

Insurance

Finances

Independence/need for assistance

Potential for isolation

Assessment of caregiver stress

132

This assessment:

–refers to the personal search for meaning and purpose in life

–integral to the care of the whole person

–grounded in person/patient-centered care

Spirituality (spiritual assessment)

133

The spiritual assessment of the older adult involves these components:

Spirituality

Religion

Worship practices

Religious artifacts

Spiritual leader/advisor

Check for S/S of spiritual distress

134

A score of 3 on the MiniCog cognitive assessment indicates a _____ screen

Negative (good cognition)

135

A score of 2 on the MiniCog cognitive assessment indicates a _____ screen

Positive (cognitive decline)

136

The first portion of the MiniCog asks the individual to do what?

Example?

Asks person to remember 3 words, such as:

Apple, table, penny

137

Third level prevention to promote health in older adults includes:

Physical/cognitive health

Functional assessment (ADLs, IADLs)

Social assessment

Spiritual assessment

138

In terms of assessment, this is the most accurate model, as report may over or underestimate function

Direct observation

139

Patient Depression Questionnaire (PDQ-9):

What 5 score values are included in this screening?

1-4 (minimal depression)

5-9 (mild depression)

10-14 (moderate)

15-19 (moderately severe)

20-27 (severe)

140

Patient Depression Questionnaire (PDQ-9):

This is required within 24 hours if score >10 or if <10 and answer >0 on Q#9

Suicide risk evaluation

141

Leading cause of nonfatal injuries in U.S. for persons aged 55-85 (> 2 Million seen in ED)

–rate higher in females than males

Falls

142

What are some consequences r/t falls?

Fractures

TBI

Loss of independence

Decreased QoL

Fear of falls

Death (75+ w/hip fx - 50% die w/in one year)

143

Morse Fall Scale scores & corresponding risk levels

0-24 (No risk)

25-50 (Low risk)

51+ (High risk)

144

A score of __ or greater on the Hendrich II Fall Risk Scale = high risk for falls

5 or greater

145

Braden Scale scores & corresponding risk levels

15-18 (at risk - low)

13-14 (moderate risk)

10-12 (high)

9 or less (very high)

146

These 4 factors affect life expectancy

Heredity

Lifestyle

Exposure to toxins in the environment

Health care

147

Age-associated CV changes

Arterial wall thickening - decreased compliance

LV & atrial hypertrophy

Sclerosis of atrial & mitral valves

Strong arterial pulses - weak peripheral pulses

Cool extremities

148

When assessing an older adult's extremities, what findings would be considered normal that would be worrisome in a younger patient?

Diminished peripheral pulses

Cooler extremities

149

Age-associated pulmonary changes

Less respiratory muscle strength

Stiffer chest wall with less compliance

Less ciliary & macrophage activity

Drier mucous membranes

Decreased cough reflex

150

Why are older adults at great risk for developing pneumonia?

Less ciliary & macrophage activity

Drier mucous membranes

Decreased cough & mucus/foreign matter clearance.

151

Why may older adults have become more hypoxic or hypercapnic before either is noticed?

Decreased response to hypoxia & hypercapnia

152

Respiratory rate norm for older adults

12-24

153

2 pulmonary complications older adults are at greater risk for

Infection

Bronchospasm w/airway obstruction

154

Age-associated GU changes

Less kidney mass, blood flow, GFR, & decreased drug clearance

Reduced bladder capacity, elasticity, & tone

Increased PVR, nocturnal urine production

Prostatic enlargement in males (risk of BPH)

155

Why are older adults at greater risk of nephrotoxic injury & adverse reactions from drugs?

Lower GFR

156

How much does GFR decline with aging?

Drops by 10% with each decade after age 30

157

Due to GU changes in the elderly, they're at greater risk for what GU complications?

Urgency

Incontinence

UTI

Nocturnal polyuria

158

Why would GU changes in the elderly place them at a greater risk for falls?

Nocturnal polyuria, leading to more trips to bathroom at night & increased potential for experiencing a fall

159

Age-associated GI changes

Decreased thirst perception

Decreased gastric motility & emptying

Atrophy of protective mucosa

Malabsorption of carbs, B12, folic acid, & Ca++

Impaired sensation to defecate

Decreased metabolism of drugs

160

Gastric changes in the older adult place them at risk for what GI complications?

Adverse drug reactions (less metabolism)

GERD

Maldigestion/malnutrition

NSAID-induced ulcers

161

Age-associated MSK changes

Sarcopenia with increased weakness & poor exercise tolerance

Fat replacing lean body mass

Bone loss in women & men after peak mass at 30-35 years

Decreased ligament & tendon strength. Articular cartilage erosion. Changes in stature with kyphosis, height reduction

162

Decline in muscle mass and strength associated with aging

Sarcopenia

163

Geriatric Assessment Tool that assesses combination of age, MMSE, & IADL function prior to admission to gather a complete score

Score values indicating a risk of decline in ADL function:

4-5: High risk

2-3: Intermediate

0-1: Low

Hospital Admission Risk Profile (HARP)

164

Age-associated neuro changes

Decrease in neurons & neurotransmitters

Compromised thermoregulation & decreased temp sensitivity

Slowed motor skills & potential deficits in balance & coordination

Increased risk of sleep disorders, delirium, neurodegenerative diseases

165

Why may it take longer to detect an infection in an older adult?

Blunted or absent fever response

*Baseline temp in older adults is 97.4 (vs. 98.6 in younger adults)

166

T/F:

Aging results in an increased ability to perceive pain

T

167

What S/S of infection or disease may be present in the older adult, considering changes that accompany the aging process?

Often subtle, include:

Nonspecific declines in function or mental status, decreased appetite, incontinence, falls, fatigue, exacerbation of chronic illness

168

Those diseases that are caused by either action or inaction on the healthcare provider's part

Iatrogenic

169

Leading cause of injury-related death in US persons 65+

Falls

170

What's the difference between intrinsic & extrinsic risk factors when discussing falls?

What risk factors should we focus on when trying to reduce risk?

Intrinsic r/t the patient (i.e. age, HX, weakness, gait)

Extrinsic r/t factors outside of patient control (i.e. stairs, handrails, bathroom grab bars, lighting, floor hazards)

*Should focus on the MODIFIABLE risk factors

171

Restraints should have a very limited use r/t the fact they increase the risk for

Falls & injury

172

Preventing falls in the nursing home can be done by...

Educating staff

Reviewing meds

Adapting environment

Teaching resident behavioral strategies

Vitamin D

Exercise/diet

173

What should the nurse do when a fall happens?

Assess

Notify - communicate

Monitor & reassess

Document

174

Risk factors for developing a pressure ulcer include:

Thin, obese

Poor nutrition

Immobility

Assistive devices

Pain meds or sedatives

Decreased LOC

175

What S/S of infection or disease may be present in the older adult, considering changes that accompany the aging process?

Nonspecific declines in function or mental status

Decreased appetite

Incontinence

Falls

Fatigue

176

The robot developed by researchers at Georgia Tech whose purpose is to bathe patients is called:

Cody

177

The Proteus® sensor system becomes activated when it:

Becomes wet from stomach acid

*Wearable and ingestible sensors that work together to gather information about medication-taking, activity and rest patterns

178

Do older adults experience a decrease in maximal HR/CO with exercise or at rest?

Decreased maximal heart rate and cardiac output with exercise

179

Paro, the robot seal, when used with dementia and stroke patients can:

1. Increase verbalization

2. Provide comfort

3. Reduce stress

4. Increase risk of infection

1,2,3

180

Gerontechnology is defined as:

Designing technology and the environment for independent living and social participation of older persons in good health, comfort and safety

181

Signs of possible physical neglect of the older adult:

a) 2 major conditions inciting suspicion

b) Other conditions

a) Pressure ulcers

Repeated falls

b) Malnutrition

Dehydration

Poor hygiene/soiled clothing

182

Older adults who go online to send e-mail or play games actually show improvement in this aspect of their lives

ADLs

183

Breast CA mammogram screening:

USPSTF recommends every other year in women __-__

50-74

184

When building system interface for older adults, error messages that pop-up should provide what 2 things?

Constructive advice

Offer suggestions

185

A residence equipped with technology that enhances safety of patients at home and monitors their health conditions

Infrastructure can be customized to address neurological and/or cognitive disorders and enhance residents’ ability to function independently within

Smart home

186

Active retirement community developed by Americare in affiliation with the MU Sinclair School of Nursing-opened in April 2004

33 units (one and two-bedroom apartments connected through a common interior)

TigerPlace

187

Provides nutrition data for foods; data based on the USDA National Nutrient Database

MyFood app

188

Allows the user to track food group consumption, glasses of water, and sweets/fats to reach diet/nutritional goals

EatRight app

189

As an RN, you're caring for an older adult in a nursing home. You suspect EM - who do you call, and what's the number?

Complaint Resolution Unit toll-free hotline at 1-800-562-6078

190

FDA-cleared mobile health solution for chronic respiratory disease

Offers expanded mobile apps for asthma, COPD and other respiratory disease

Asthmapolis (now Propeller Health)

191

Extra batteries for hearing aids should be stored where?

In wheel

In dry place

*Expire over time, so keep battery tester on hand

192

1. Behind-the-ear (BTE) & Inside-the-ear (ITE) hearing aids are inserted this way

2. They're removed this way

1. Hold in position as if already in ear, insert with a twist (should lock into place)

2. Break seal of earmold by manipulating pinna, gently twist forward & pull out

193

1. Inside-the-canal (ITC) hearing aids are inserted this way

2. They're removed this way

1. Usually R=red, L=blue; pull string should be closer to bottom, insert into canal & pull string (should lock into place)

2. Pull string to release from canal, then pull out

194

3 steps to changing hearing aid battery

1. Open door

2. Insert battery w/+ facing up (flat side)

3. Close (if you have to force it, it's probably in wrong)

195

Patient should have their hearing aid checked and cleaned by an audiologist how often?

Q 6 months

196

Where should hearing aids be stored when not in use?

Away from water (in dry place)

Away from source of heat (i.e. heater/radiator)

Take off before applying cosmetics (cologne, perfume, hair spray, hair dryer, etc)

Keep both hearing aids & batteries away from children & pets!

197

1. When cleaning the hearing aid, should you insert something into the microphone or receiver to clean it?

2. Can you use fluid to clean the hardware?

NO to both!

198

Suggested List of Hearing Aid Supplies includes:

Brush

Earmold blower

Battery tester & extra batteries

Audio-wipes

Dri-Aid kit (leave hearing aid in overnight to dry)

199

As the baby boomer generation grows old and if the number of elderly care workers fails to grow with it, many people might end up being cared for by these...

Robots

200

Researchers at the Georgia Institute of Technology have developed this robotic nurse, which the university says is “gentle enough to bathe elderly patients”

Cody

201

Made by researchers at Carnegie Mellon, this robot is designed to fetch household objects like cups and can even clean a kitchen

Home Exploring Robot Butler (HERB)

202

This robot, being developed by the University of Reading in England, can remind patients to take their medicine, keep track of their eyeglasses and assist in the event of a fall

Hector

203

T/F:

Older women make up the majority of those abuse cases that are reported to Adult Protective Services (APS) in the U.S.

T

204

T/F:

The perpetrator of elder abuse is generally a stranger

F

205

T/F:

Neglect occurs when a person who has assumed the care of a vulnerable elder deserts the older adult

F (abandonment)

206

In Washington State, if the older adult is residing in the home of a relative, and the nurse suspects abuse, how should he/she report it?

Local APS office

*Adult Protective Services

207

T/F:

The Elder Assessment Instrument allows the nurse to definitely determine if abuse has occurred or not

F

208

Barriers to reporting suspected elder abuse (EM) include:

Time constraints

Lack of knowledge regarding process of reporting

Fear of legal action

209

When completing the Elder Assessment Instrument in a cognitively impaired older adult who is unable to fully describe symptoms, the appropriate actions include:

Get info from family members

Observe patient responses

210

It is common for family members of older adults experiencing abuse at the hands of health care providers or paid caregivers to express feelings of:

Guilt

211

Which option below is NOT a recognized challenge to the diagnosis and treatment of infections in older adult populations?

a) Atypical presentation of infections

b) Presence of comorbid conditions

c) Aging-related cognitive decline

d) Altered immune status

c) Aging-related cognitive decline

212

Which of the following is NOT a typical representation of Herpes zosterinfection in older adults?

a) The presence of pain and paresthesias in the affected dermatome

b) The person will develop low-grade fever, malaise, and an erythematous-based vesicular rash over the affected area as soon as he/she is infected

c) Post-herpetic neuralgia is characterized by pain that persists for at least 30 days after clearing of the zoster rash

d) The pain related to post-herpetic neuralgia can decrease an older adult's functional status, which can lead to decreaed mobility, decreased nutritional intake, and increased susceptibility in other infections.

b) The person will develop low-grade fever, malaise, and an erythematous-based vesicular rash over the affected area as soon as he/she is infected

213

S/S typical of the initial clinical presentation of PNA in an older adult:

Changes in mentation - delirium

Weight loss

Lethargy

Decreased food intake

214

Which of the following age-related changes in the urinary tract system increase the risk of urinary tract infections (UTIs)?

1. Reduced peak bladder capacity
2. Increased residual volume
3. Increased glomerular filtration
4. Decreased renal blood flow

1, 2, 4

215

T/F:

Older adults tend to have less or delayed febrile responses to infections due to decreased physiological homeostatic control

T

216

Post-menopausal women are at increased risk of _____ due to changes in estrogen levels that lead to decreased lactobacilli and increased pH

UTI

217

What Braden score range in older adults is considered to place the patient "at high risk" for pressure ulcers?

10-12

218

Which of the following statements about falls in older adults are TRUE

(check all that apply)

a) Urinary incontinence increases a person's risk of falling

b) Fear of falling makes an older adult more careful and therefore decreases the risk of falling

c) Fear of falling increases an older adult's risk for falling

d) Women are more likely than men to have a fracture during a fall

e) None of the above are true

a) Urinary incontinence increases a person's risk of falling

c) Fear of falling increases an older adult's risk for falling

d) Women are more likely than men to have a fracture during a fall

219

žActs or failures to act that result in harm or a serious threat of harm to the health or welfare of a vulnerable older adult

Elder Mistreatment (EM)

220

Behavior of an older adult that threatens his/her own health and safety

žAssociated with increased risk for elder abuse; median time SN to EA 3.5 years

Self-Neglect (SN)

221

A bruise is more likely to be r/t abuse if it has these characteristics

Large

Head, arms, back

*Most can recall how they got the bruise, even those with memory problems and/or dementia

222

Financial/material neglect should be considered in these circumstances:

Substandard care despite adequate $

Elder is confused r/t financial situation

Assets have been suddenly transferred

223

As an RN, what's your responsibility as far as reporting EM or abuse, and how do you go about it (esp. if it's a resident vs. an older adult living at home with a relative caregiver)?

As a mandatory reporter, you MUST by law make a report if you have reason to believe abuse, abandonment, neglect, or financial exploitation of a vulnerable adult has occurred.

To report abuse or neglect of a vulnerable adult in Washington State, call the:

  • Complaint Resolution Unit toll-free hotline at 1-800-562-6078 if the person that you suspect is being abused or neglected is living in a nursing home, boarding home, or adult family home.
  • Local Adult Protective Services (APS) office if the person you suspect is being abused is living in their own home or somewhere other than a residential care facility.
224

Why might an older adult fear the removal of a caregiver, even if there's abuse involved?

Fear of going to nursing home

225

The maximum total score is 28 points. In general, patients who score below 19 are at a high risk for falls. Patients who score in the range of 19-24 indicate that the patient has a risk for falls.

Tinetti

226

PDQ-9:

Your patient scores 6 points on the questionnaire. What risk level is he/she at?

Mild depression risk (5-9)

227

PDQ-9:

Your patient scores 12 points on the questionnaire. What risk level is he/she at?

Moderate depression risk (10-14)

228

PDQ-9:

Your patient scores 18 points on the questionnaire. What risk level is he/she at?

Moderate-severe depression risk (15-19)

229

PDQ-9:

Your patient scores 20 points on the questionnaire. What risk level is he/she at?

Severe depression risk (20-27)

230

PDQ-9:

Your patient scores 4 points on the questionnaire. What risk level is he/she at?

Minimal depression risk (1-4)

231

CV changes in the OA:

Quality of pulses

Strong arterial

Weak peripheral (cool extremities)

232

Mini-Cog scores:

1. + screen

2. - screen

+ (0-2) indicating decline

- (3-5)