Basic Geriatric Nursing - midterm

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1

Ageism

The disliking of aging and older people based on the belief that aging makes people unattractive, unintelligent, and unproductive.

2

gerontophobia

The fear of aging and the refusal to accept older adults into the mainstream of society.

3

National Institute on Aging reports

  1. 1. older patients receive less information than do younger patients
  2. Less information is provided to older adults on lifestyle changes
  3. limited rehabilitation is available for older adults with chronic disease
  4. Only 74% of physicians feel that older adults should receive the same evaluation and treatment for acute illness than younger counterparts.
4

The Nursing Competence in Aging

Started in 2002, focuses on enhancing competence in geriatrics by expanding nurses knowledge, skills and attitudes.

5

Levy found

that younger people who hold positive feelings towards the elderly live 7.5 years longer than those with negative perceptions of aging.

6

Demographics

The statistical study of human populations. Concerned with size, distribution, and vital statistics.

7

Age cohort

A term used by demographers to describe a group of people born within a specified time.

8

Basic care facilities

provide the level of care and supervision necessary to maintain the residents safety and well-being

9

Skilled care facilities

provide skilled nursing care on a regular basis

10

subacute care facilities

provide comprehensive inpatient care designed for individuals comprehensive inpatient care designed for individuals who have an acute illness, injury or exacerbation of disease process.

11

Medicare

Government program that provides health care funding for older adults and those with disabilities. 65 of older qualify.

12

Medicare Part A

covers inpatient hospital care; extended care in a skilled nursing facility following hospitalization; only after the patient pays an initial deductible and any co-pay expense

13

Diagnosis-related group

A Medicare instituted system in an attempt to contain hospital costs.

14

Medicare Part C

coverage was available to individuals who are eligible for Part A and enrolled in Part B. Includes Advantage or Choice plans

15

Medicare Part D

Prescription drug coverage...voluntary plan available to anyone enrolled in Part A or B

16

Supplemental Medicaid

Assistance may be available for those older adults who meet certain financial need requirements.

17

PPACA -Patient Protection and Affordable Care Act

Includes numerous health-related provisions to take effect over several years...signed into law by P. Obama

18

Advance Directives

  1. DNAR
  2. directives related to mechanical ventilation
  3. directives related to artificial nutrition and hydration.
19

Two Formal Advance Directives

  1. The durable power of attorney for health care
  2. the living will
20

Durable Power of attorney

transfers the authority to make health care decisions to another person, called the health care agent.

21

A living will

informs physician that the individual wishes to die naturally if he or she develops an illness or receives an injury that cannot be cured. Prohibits the use of life-prolonging measure and equipment.

22

The most significant issue that aging parents and their children must face

Loss of independence

23

Abuse and neglect

are usually something done to someone, but, unfortunately, self-neglect is a common problem in the older adult population.

24

Types of abuse

  1. self-neglect - not taking care of one self
  2. physical abuse - causing physical pain
  3. abuse or neglect by the family - physical or verbal
  4. neglect - passive form of abuse
  5. Emotional abuse - isolating, ignoring
  6. Financial Abuse - withholding or misusing elders funds
  7. Abandonment - leaves the elder physically, emotionally, and financially defenseless.
25

Responses to abuse

Elder does not complain in fear of being treated even worse or fear of being institutionalized or abandoned my prevent the victim from seeking help.

26

Medicare legislation was established in the

1960's

27

Percentage of senior citizens who live independently in a family setting is approximately

70%

28

Progeria

children who have the physiology and appearance of 70-year-olds

29

The leading cause of disability over age 65

heart disease

stroke

arthritis

hypertension

accidents

diabetes mellitus

cancer

and diseases of the ears and eyes

30

Five leading causes of death among older adults

  1. heart disease
  2. cancer
  3. cardiovascular disease (primarily stroke)
  4. pneumonia
  5. chronic obstructive pulmonary disease
31

epidermis

the outermost layer of the skin that provides protection for internal structures, keeps out dangerous chemicals and microorganisms, fluid regulation system, regulate body temperature

32

melanin

Melanocytes that produce the pigment _________which provides protection from ultraviolet radiation

33

dermis

contains collagen and elastin fibers, which give strength and elasticity to the tissues

34

sebaceous

oil producing

35

eccrine

sweat producing

36

Hair and nails are composed of dead ______cells

keratinized

37

Subcutaneous tissue

consists of areolar connective tissue which connects the skin to the muscles, and adipose tissue which provides a cushion over tissue and bone. WBC's are available to protect the body from microbial invasion through the skin.

38

senile lentigo

Condition in which clusters of melanocytes can form in areas of deepened pigmentation. (age spots, liver spots)

39

seborrheic keratosis

condition of slightly raised, wart like macules with distinct edges appear. can cause discomfort or itching.

40

Cutaneous

skin tags that are small, brown or flesh-colored projections of skin.

41

xerosis

dry skin

42

pruritis

dry skin accompanied by itching due to diminished circulation

43

senile purpura

Condition when the walls of the capillaries become increasingly fragile with age and may hemorrhage, leading to the red, purple, or brown areas seen on the legs and arms.

44

Basal Cell Carcinoma

Malignant epithelial neoplasm that tends to invade surrounding tissue and to metastasize to distant regions of the body.

45

Melanoma

A potentially deadly form of skin cancer due to its ability to metastasize.

46

Rosacea

appears as redness, dilated superficial blood vessels and small pimples on the nose and center of the face.

47

Forms of dermatitis

contact, allergic, and seborrheic dermatitis. Appear as rashes or inflammation that is either localized to certain areas of the body or generalized.

48

Seborrheic dermatitis

an unsightly skin condition characterized by yellow, waxy crusts that can be either dry or moist caused by excessive sebum production.

49

Is needed for the absorption of calcium and phosphate through the small intestine

Vitamin D

50

Needed for ossification or bone matrix formation

Vitamins A & C

51

Calcitonin

is produced by the thyroid gland, slows the movement of calcium from the bones to the blood and lowers the blood calcium level

52

PTH

increases the movement of calcium from the bones to the blood and increases the blood calcium level.

53

Tendons

connects muscles to the bone

54

Ligaments

connect bone to bone

55

Tuberculosis

an infectious disease caused by the bacillus which spreads by means of airborne droplets

56

One of the most deadly forms of cancer in the United States

Lung Cancer

57

Orthostatic hypotension

occurs because the circulation does not respond quickly to postural changes

58

MI

heart attack

59

cardiomegaly

enlargement of the heart

60

intermittent claudication

manifests as a cramping pain in the legs during or after walking.

61

Absorption of nutrients occurs primarily in the

small intestine

62

prophylactic

use of medications such as aspirin and vitamin E thought to decrease risk for stroke, heart attack and Alzheimer's disease.

63

Empathy

defined as the willingness to attempt to understand the unique world of another person.

64

To establish an empathetic climate, the most effective method is to use

open-ended responses

65

normal pulse rate in adults ranges from

60-90 bpm

66

Pulse can be assessed at various sites on the body including:

temporal, carotid, brachial, radial, femoral, popliteal, posterior tibial, and dorsalis pedis arteries as well as the apex of the heart

67

When apical and radial readings are different this is called

pulse deficit

68

Body system physical assessment starts and ends---in order

skin

nails

hair

skull, face and neck

eyes

ears

respiratory

cardiovascular

GI

musculoskeletal

neurologic

genitourinary

69

SPICES - a acronym for six common marker condition stands for

Sleep disorders

Problems with eating or feeding

Incontinence

Confusion

Evidence of falls

Skin breakdown

70

FANCAPES used to organize assessment when nurse suspects something that an actual emergency or serious problem is present stands for

Fluid

Aeration

Nutrition

Cognition, communication

Activity / abilities

Pain

Elimination

Skin / socialization

71

The assessment tool that is most commonly used to determine the mental status of the elderly person

Mini-Mental State Examination

72

Coarse, low-pitched sounds would be reported as

Rhonchi (gurgles)

73

Order of assessment

Obtain a health history

Inspect the oral cavity

Observe abdomen for scars

Auscultate bowl sounds

Palpate abdomen

74

Gouty Arthritis

Inborn error of metabolism that results in elevated uric acid in body.

75

Baby Boomers

Cohorts

1946-1964

76

Medicare signed into law

1960's

77

Chyme

What is called once food has been processes in the stomach

78

Urine is ______ and ____________

95% water and the rest is waste & salt

79

angina pectorsis

chest pain / ischemic

80

hypercholemic acidosis

loss of too much sodium bircobonate

81

CVA

Stroke

82

MI

Heart attack

83

TIA

brief episodes of cerebrovascular insufficiency (embolus)

84

medulla

controlls vital functions ie HR, RR, V/S

85

cerebrum

largest part of the brain

86

apex

tip of the heart

87

hinge joint

elbow

88

pivot joint

1st cervical vertebra - atlas against 2nd cervical vertebra - axis

89

plane / gliding joint

between vertebrae

90

ellipsoid

atlas articulating with occipital condyle

91

saddle joint

base of thumb, carpal and metacarpal

92

Ball and socket

Shoulder / hip

93

What is the most important thing in healthcare?

Quality of care, wellness and extended life expectancy

94

When is a living will activated?

When patient has non-cognitive function

95

How is a living will legalized?

Notary

signed by 2 physicians

when Patient is cognitive to sign for self

96

Medicare reduced what?

The cost as well as time span of hospital stay allowed and financial savings

97

When are restraints on elderly considered legal

When you have a physician order

98

Biologic theories of aging

The attempt to explain why the physical changes of aging occur such as the programmed Theory which proposes that everyone has a "biological clock" that starts at the time of conception.

99

Neuroendocrine Theory

Focuses on the complicated chemical interactions set off by the hypothalamus of the brain

100

Activity Theory

Proposes that activity is necessary for successful aging - "busy work"

101

Jung's Theory

Proposes that development continues throughout life by a process of searching, questioning and setting goals that are consistent with the individuals personality search for "true-self"

102

Havighurst's Theory

Process of aging and tasks late in life.

  • Adjustment to decreased physical strength and health
  • Adjusting to retirement and decreased income
  • Adjusting to the loss of a spouse
  • Establishing a relationship with one's own age group
  • Adapting to social roles in a flexible way
  • Establishing satisfactory living arrangements
103

What is the stage in Erikson's Theory that he considered to be the primary developmental task of the elderly?

Integrity v Despair

104

If a patient is non-compliant, what should the nurse address?

Educational level

Cultural barriers

Communication barriers

knowledge level of patient

105

What should you never give a patient?

False hope

106

What do you do when there is a language barrier between the nurse and the patient?

Request an Interrupter

107

What is the common back safety technique nurses should use

Bend at the knees

Keep patient in a high position when changing linens or performing care - return bed to lower position when complete.

108

What would you encourage for a patient that has a UTI?

Increase in fluid intake

109

What does urine consist of?

95% water and the rest is waste and salt

110

Angina pectorsis

Chest pain (ischemic)

111

Cardiomeagly

enlarged heart

112

What are Vit A,C,E?

Antioxidants

113

Vitamins A,D,E,K

are fat-soluble

114

Vitamins B & C

are water-soluble

115

B12 is known to help with what?

Neurological changes effecting sensation, balance, memory and energy

116

Vitamin A

Decreases poor wound healing

117

Vitamin C

Decreases weakness, dry mouth, skin changes

118

Vitamin D

Decreases excessive bone demineralization / osteoporosis (Sun needed)

119

Vitamin E

Plays a role in maintaining immune function delay and onset Alzheimer's disease

120

Proteins are

amino acids

121

Gouty Arthritis

Inborn error of metabolism that results in elevated uric acid in the body

122

What is the range of specific gravity?

1.010 to 1.025

If below range it is considered dilute

If above range it is considered concentrated

123

What does food become once it has been processed in the stomach?

Chyme

124

Acidosis

Too much acid in the body fluids

125

Alkalosis

Too much base in the body fluids

126

Diabetic acidosis

Keytone build up in the body during uncontrolled diabetes

127

What does DRG stand for and what was it instituted for?

Diagnosis-Related Group

1980's - instituted this system in an attempt to contain hospital costs - results in quicker discharge of sicker people - before recovery is complete.

128

AARP - American Association of Retired Persons

  • Consists of members at least 50 years and their spouses regardless of age
  • Currently has 30 million members
  • Could have 76 million when Baby Boomers reach age 50
  • Uses volunteers and lobbyists to advance the political and economic interest of older adults
  • Provides a wide variety of membership benefits, including insurance programs and discounts
129

NCSC - National Council of Senior Citizens

  • Has 4.5 million members
  • Focuses on political and legislative issues
130

Aging Theories

Biologic Theories

131

Gene Theory

Proposes the existence of one or more harmful genes that activate over time - limiting the lifespan of the individual.

132

Antioxidants

Vitamins A, C, E, Carotenoids, zinc, selenium, phytochemicals - proposed to reduce the number of free radicals if used

133

Verbal communication

Involves sending and receiving messages by means of words

134

Therapeutic communication

Conscious and deliberate process used to gather information related to a patient's overall health status and to respond with verbal and nonverbal approaches that promote the patient's well-being.

135

Nonverbal communication

Symbols - uniform styles and colors

Body Language -

Watching for messages that patients are communicating to us without words

Gestures - Highly cultural and generational

Facial Expressions

136

Define aphasia

After a stroke brain damage occurs in some individuals that will cause them to not recognize words or to "find" the words they want to use.

137

Patient with a hip replacement needing extended care would go to what type of facility?

Skilled Care

138

Biological Clock =

Biological Theory

139

Elderly is on a restricted salt diet what would you recommend in patient teaching?

Read the labels of the foods before purchasing

140

Some elderly will use what as a sleep aid?

Alcohol

141

Recommending a patient keep a list of all meds is a result of

Polypharmacy

142

The liver is the primary site of drug _________________

metabolism

143

Presbycusis

Hearing loss associated with aging, particularly of higher-pitched sounds

144

Presbyopia

Found in older people, farsightedness resulting from a loss of elasticity of the lens of the eye and resulting in a decrease in the power of accomodation

145

Psychosocial Theories of aging

Attempt to explain why older adults have different responses to the aging process

146

Ischemic

Related to a decreased supply of oxygenated blood, as in eschemic heart disease, a pathologic condition caused by a lack of oxygen in cells of the myocardium

147

How would you communicate with someone who has receptive asphagia?

Communicate using gestures

148

The American Cancer Society recommends that after age 50 woman should do what every year?

FECAL OCCULT BLOOD TEST

149

what can you expect from an 86 year old who has age related loss of subcutaneous fat and lowered metabolism rate?

Keep patient from getting chilled, offer a blanket

150

What is the Mini-Mental State Examination (MMSE) used to evaluate on an elderly patient?

Attention and ability to perform calculations

151

Wart like dark macules

Seborrheic Keratosis

152

Non-blanch-able area of erthemia near the coccyx area is known as ____________

Stage 1 ulcer

153

What would a 15 minute walk every day do for a post menopausal woman?

Improve bone health

154

A person with a hemorrhagic CVA to the left hemisphere would exhibit what?

Impaired mobility

155

Number one nursing strategy to preventing falls in elderly patients in a skilled unit?

Answer the CALL light

156

What is a safety hazard in an elderly living home?

Throw rugs

157

Health Maintenance

A systemic program planned to prevent illness, to maintain maximal function and quality of life

158

Health Screening

Done to identify older individuals who are in need of further, more in-depth assessment

159

Health Assessment

Time consuming and must be performed by skilled professional. Includes the collection of all of the important health related data using a variety of techniques such as data collection, subjective and objective

160

The apical heartbeat is best heard by placing the stethoscope where?

Over the fifth intercostal space even with the middle of the clavicle...should be counted for a full minute.

161

Cardiovascular changes in aging

Arteriosclerotic changes often result in decrease or complete loss of palpable pulses in the lower extremities...

162

Orthostatic hypotension

The sudden drop in blood pressure that occurs when a person changes from a lying to a sitting position or from sitting to standing.

163

Otosclerosis

loss of hearing resulting from decreased sound transmission

164

Ringing in the ears (tinnitus)

Can be caused by Meniere's disease, age related changes or medications.

165

Perception includes

The collection, interpretation and recognition of stimuli, including pain

166

Cognition includes

intelligence, memory, language and decision making.

167

hemianopsia

When an older person has a condition in which a portion of the visual field is lost.

168

Confusion

defined as a mental state characterized by disorientation regarding time, place, or person that leads to bewilderment, perplexity, lack of orderly thought, and the inability to choose or act decisively and to performs the ADL's of daily living.

169

delirium

characterized by disturbances in cognition, attention, memory, and perception.

170

Dementia

slow, insidious process that results in progressive loss of cognitive function. Caused by damage to the cerebral cortex that is most commonly secondary to multiple infarcts of the cerebrum secondary to stroke, or other pathologic conditions of the brain.

171

Wernicke's aphasia

The person is able to speak, but the words produces my be nonsensical or have little connection to reality....

172

expressive aphasia

the person is unable to express himself or herself using language

173

Global aphasia

when the person loses the ability both to understand language and to express oneself using language.

174

The most common problems experienced by older adults

Perceptual changes

175

When administering iron what is the nursing process?

Remember it can irritate the GI - so take during or after meals

Given by injection - use the Z-track method due to staining risk of the skin

If liquid use a straw so as not to stain the teeth.

assess the stool due to possible side of diarrhea

176

Vision should be checked __________________to monitor glaucoma or other eye problems

yearly

177

The pneumonia vaccine is given starting at ______ or ________ years of age and repeated every _________years is recommended

65 or 70

10

178

Influenza vaccine must be obtained on a _____________basis

yearly basis usually in the fall.

179

Tetnus although rare in the US, half affect the elderly. Immunizations should be done in a three dose series of injections and should be repeated ________years

every 10

180

Shingle vaccine is recommended for people over age _________

60

181

Hepatitis B immunizations are based on

individual risk factors and should be discussed with the physician

182

Dental examinations should be obtained and an inspection of the oral cavity performed on a regular basis of at least ______________________

once a year

183

What factors are associated with non-compliance?

cognitive impairment

inadequate knowledge

lack of transportation

fear

anger

decreased self-esteem, substance abuse and conflict of beliefs or values