Basic Geriatric Nursing - midterm
The disliking of aging and older people based on the belief that aging makes people unattractive, unintelligent, and unproductive.
The fear of aging and the refusal to accept older adults into the mainstream of society.
National Institute on Aging reports
- 1. older patients receive less information than do younger patients
- Less information is provided to older adults on lifestyle changes
- limited rehabilitation is available for older adults with chronic disease
- Only 74% of physicians feel that older adults should receive the same evaluation and treatment for acute illness than younger counterparts.
The Nursing Competence in Aging
Started in 2002, focuses on enhancing competence in geriatrics by expanding nurses knowledge, skills and attitudes.
that younger people who hold positive feelings towards the elderly live 7.5 years longer than those with negative perceptions of aging.
The statistical study of human populations. Concerned with size, distribution, and vital statistics.
A term used by demographers to describe a group of people born within a specified time.
Basic care facilities
provide the level of care and supervision necessary to maintain the residents safety and well-being
Skilled care facilities
provide skilled nursing care on a regular basis
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.
Government program that provides health care funding for older adults and those with disabilities. 65 of older qualify.
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
A Medicare instituted system in an attempt to contain hospital costs.
Medicare Part C
coverage was available to individuals who are eligible for Part A and enrolled in Part B. Includes Advantage or Choice plans
Medicare Part D
Prescription drug coverage...voluntary plan available to anyone enrolled in Part A or B
Assistance may be available for those older adults who meet certain financial need requirements.
PPACA -Patient Protection and Affordable Care Act
Includes numerous health-related provisions to take effect over several years...signed into law by P. Obama
- directives related to mechanical ventilation
- directives related to artificial nutrition and hydration.
Two Formal Advance Directives
- The durable power of attorney for health care
- the living will
Durable Power of attorney
transfers the authority to make health care decisions to another person, called the health care agent.
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.
The most significant issue that aging parents and their children must face
Loss of independence
Abuse and neglect
are usually something done to someone, but, unfortunately, self-neglect is a common problem in the older adult population.
Types of abuse
- self-neglect - not taking care of one self
- physical abuse - causing physical pain
- abuse or neglect by the family - physical or verbal
- neglect - passive form of abuse
- Emotional abuse - isolating, ignoring
- Financial Abuse - withholding or misusing elders funds
- Abandonment - leaves the elder physically, emotionally, and financially defenseless.
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.
Medicare legislation was established in the
Percentage of senior citizens who live independently in a family setting is approximately
children who have the physiology and appearance of 70-year-olds
The leading cause of disability over age 65
and diseases of the ears and eyes
Five leading causes of death among older adults
- heart disease
- cardiovascular disease (primarily stroke)
- chronic obstructive pulmonary disease
the outermost layer of the skin that provides protection for internal structures, keeps out dangerous chemicals and microorganisms, fluid regulation system, regulate body temperature
Melanocytes that produce the pigment _________which provides protection from ultraviolet radiation
contains collagen and elastin fibers, which give strength and elasticity to the tissues
Hair and nails are composed of dead ______cells
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.
Condition in which clusters of melanocytes can form in areas of deepened pigmentation. (age spots, liver spots)
condition of slightly raised, wart like macules with distinct edges appear. can cause discomfort or itching.
skin tags that are small, brown or flesh-colored projections of skin.
dry skin accompanied by itching due to diminished circulation
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.
Basal Cell Carcinoma
Malignant epithelial neoplasm that tends to invade surrounding tissue and to metastasize to distant regions of the body.
A potentially deadly form of skin cancer due to its ability to metastasize.
appears as redness, dilated superficial blood vessels and small pimples on the nose and center of the face.
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.
an unsightly skin condition characterized by yellow, waxy crusts that can be either dry or moist caused by excessive sebum production.
Is needed for the absorption of calcium and phosphate through the small intestine
Needed for ossification or bone matrix formation
Vitamins A & C
is produced by the thyroid gland, slows the movement of calcium from the bones to the blood and lowers the blood calcium level
increases the movement of calcium from the bones to the blood and increases the blood calcium level.
connects muscles to the bone
connect bone to bone
an infectious disease caused by the bacillus which spreads by means of airborne droplets
One of the most deadly forms of cancer in the United States
occurs because the circulation does not respond quickly to postural changes
enlargement of the heart
manifests as a cramping pain in the legs during or after walking.
Absorption of nutrients occurs primarily in the
use of medications such as aspirin and vitamin E thought to decrease risk for stroke, heart attack and Alzheimer's disease.
defined as the willingness to attempt to understand the unique world of another person.
To establish an empathetic climate, the most effective method is to use
normal pulse rate in adults ranges from
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
When apical and radial readings are different this is called
Body system physical assessment starts and ends---in order
skull, face and neck
SPICES - a acronym for six common marker condition stands for
Problems with eating or feeding
Evidence of falls
FANCAPES used to organize assessment when nurse suspects something that an actual emergency or serious problem is present stands for
Activity / abilities
Skin / socialization
The assessment tool that is most commonly used to determine the mental status of the elderly person
Mini-Mental State Examination
Coarse, low-pitched sounds would be reported as
Order of assessment
Obtain a health history
Inspect the oral cavity
Observe abdomen for scars
Auscultate bowl sounds
Inborn error of metabolism that results in elevated uric acid in body.
Medicare signed into law
What is called once food has been processes in the stomach
Urine is ______ and ____________
95% water and the rest is waste & salt
chest pain / ischemic
loss of too much sodium bircobonate
brief episodes of cerebrovascular insufficiency (embolus)
controlls vital functions ie HR, RR, V/S
largest part of the brain
tip of the heart
1st cervical vertebra - atlas against 2nd cervical vertebra - axis
plane / gliding joint
atlas articulating with occipital condyle
base of thumb, carpal and metacarpal
Ball and socket
Shoulder / hip
What is the most important thing in healthcare?
Quality of care, wellness and extended life expectancy
When is a living will activated?
When patient has non-cognitive function
How is a living will legalized?
signed by 2 physicians
when Patient is cognitive to sign for self
Medicare reduced what?
The cost as well as time span of hospital stay allowed and financial savings
When are restraints on elderly considered legal
When you have a physician order
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.
Focuses on the complicated chemical interactions set off by the hypothalamus of the brain
Proposes that activity is necessary for successful aging - "busy work"
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"
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
What is the stage in Erikson's Theory that he considered to be the primary developmental task of the elderly?
Integrity v Despair
If a patient is non-compliant, what should the nurse address?
knowledge level of patient
What should you never give a patient?
What do you do when there is a language barrier between the nurse and the patient?
Request an Interrupter
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.
What would you encourage for a patient that has a UTI?
Increase in fluid intake
What does urine consist of?
95% water and the rest is waste and salt
Chest pain (ischemic)
What are Vit A,C,E?
Vitamins B & C
B12 is known to help with what?
Neurological changes effecting sensation, balance, memory and energy
Decreases poor wound healing
Decreases weakness, dry mouth, skin changes
Decreases excessive bone demineralization / osteoporosis (Sun needed)
Plays a role in maintaining immune function delay and onset Alzheimer's disease
Inborn error of metabolism that results in elevated uric acid in the body
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
What does food become once it has been processed in the stomach?
Too much acid in the body fluids
Too much base in the body fluids
Keytone build up in the body during uncontrolled diabetes
What does DRG stand for and what was it instituted for?
1980's - instituted this system in an attempt to contain hospital costs - results in quicker discharge of sicker people - before recovery is complete.
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
NCSC - National Council of Senior Citizens
- Has 4.5 million members
- Focuses on political and legislative issues
Proposes the existence of one or more harmful genes that activate over time - limiting the lifespan of the individual.
Vitamins A, C, E, Carotenoids, zinc, selenium, phytochemicals - proposed to reduce the number of free radicals if used
Involves sending and receiving messages by means of words
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.
Symbols - uniform styles and colors
Body Language -
Watching for messages that patients are communicating to us without words
Gestures - Highly cultural and generational
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.
Patient with a hip replacement needing extended care would go to what type of facility?
Biological Clock =
Elderly is on a restricted salt diet what would you recommend in patient teaching?
Read the labels of the foods before purchasing
Some elderly will use what as a sleep aid?
Recommending a patient keep a list of all meds is a result of
The liver is the primary site of drug _________________
Hearing loss associated with aging, particularly of higher-pitched sounds
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
Psychosocial Theories of aging
Attempt to explain why older adults have different responses to the aging process
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
How would you communicate with someone who has receptive asphagia?
Communicate using gestures
The American Cancer Society recommends that after age 50 woman should do what every year?
FECAL OCCULT BLOOD TEST
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
What is the Mini-Mental State Examination (MMSE) used to evaluate on an elderly patient?
Attention and ability to perform calculations
Wart like dark macules
Non-blanch-able area of erthemia near the coccyx area is known as ____________
Stage 1 ulcer
What would a 15 minute walk every day do for a post menopausal woman?
Improve bone health
A person with a hemorrhagic CVA to the left hemisphere would exhibit what?
Number one nursing strategy to preventing falls in elderly patients in a skilled unit?
Answer the CALL light
What is a safety hazard in an elderly living home?
A systemic program planned to prevent illness, to maintain maximal function and quality of life
Done to identify older individuals who are in need of further, more in-depth 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
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.
Cardiovascular changes in aging
Arteriosclerotic changes often result in decrease or complete loss of palpable pulses in the lower extremities...
The sudden drop in blood pressure that occurs when a person changes from a lying to a sitting position or from sitting to standing.
loss of hearing resulting from decreased sound transmission
Ringing in the ears (tinnitus)
Can be caused by Meniere's disease, age related changes or medications.
The collection, interpretation and recognition of stimuli, including pain
intelligence, memory, language and decision making.
When an older person has a condition in which a portion of the visual field is lost.
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.
characterized by disturbances in cognition, attention, memory, and perception.
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.
The person is able to speak, but the words produces my be nonsensical or have little connection to reality....
the person is unable to express himself or herself using language
when the person loses the ability both to understand language and to express oneself using language.
The most common problems experienced by older adults
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
Vision should be checked __________________to monitor glaucoma or other eye problems
The pneumonia vaccine is given starting at ______ or ________ years of age and repeated every _________years is recommended
65 or 70
Influenza vaccine must be obtained on a _____________basis
yearly basis usually in the fall.
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
Shingle vaccine is recommended for people over age _________
Hepatitis B immunizations are based on
individual risk factors and should be discussed with the physician
Dental examinations should be obtained and an inspection of the oral cavity performed on a regular basis of at least ______________________
once a year
What factors are associated with non-compliance?
lack of transportation
decreased self-esteem, substance abuse and conflict of beliefs or values