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Gerontology
Test 1
| Question | Answer |
|---|---|
| Aging | -Process that begins with birth -Applies to both young and old -Aging Child - more opportunities -Aging Adult - negative connotation |
| Functional Age | -Don't focus on external features -What people are capable of not their chronological age |
| Ageism | Prejudices and stereotypes that are applied to older people based only on age |
| Multiple Jeopardy | Discrimination based on various attributes - age, sex, race |
| Implicit Ageism | -Thoughts, feelings and behaviors toward elderly without conscious awareness -Negative feelings are triggered merely by seeing an elder |
| Life Changes with Age | -Retirement -Role changes - no longer bread winner/care giver -Life Review - What they've done in life -Widowhood -Fixed Income - Social Security -Health Changes -All have an effect on aging |
| Promote Wellness in Older Adults | -Focus on adding life to years, not just years to life -Age related factors are inevitable but problems are associated with risk factors -Nurses can play a major role |
| Age-Related Changes | Physiologic processes that increase the vulnerability of older people to the negative impact of risk factors -Changes in sensation, vision, hearing - Positive opportunities for greater spirituality and emotional development |
| Risk Factors | Have significant detrimental effect on health and functioning - Smoking, obesity, inadequate exercise, progressive arthritis, adverse medication effect, effect of glare, background noise |
| Hartford Institute for Geriatric Nursing | -With AACN prepared BSN gerontological competencies for the graduating BSN nurse -Endowmment to help care of eldery |
| History of Gerontological Nursing | -1960-Recognized as a nursing specialty -1969-first ANA nursing standards of practice for geriatric nursing -1970s- changed to Gerontological nursing |
| Health Promotion | -Health and wellness, not illness -Living with disease/chronic illness not just having one -Disease Prevention and Health Promotion - Screening programs; risk reduction; Modification of the environment; Health Education |
| Health Teaching: Purpose | -Promote wellness -Programs - Exercise and fitness; Nutrition; Medication; Smoking cessation; Injury prevention; Preventative health services |
| Health Teaching: Domains of Learning | -Cognitive - facts; learning in traditional way -Psychomotor- better than most ways; actually doing something -Affective- How to motivate someone to learn |
| Health Teaching: Assessment | -What they don't know/understand? -Patient's capability and tools available -Assess: Sensory function; Mental Status; Past knowledge; Ability to read and write; Favored learning style |
| Health Teaching: Effects | Effects of health problems on learning: Memory; Vision and Hearing: Fatigue; Anxiety/ Depression; Signs/ Symptoms of disease process/ Motivation |
| Theories of Aging | -Variety of theories -Used to explain why people age, what triggers aging -None fully explain the aging process - People age in a very indiv. manner -Aging is a very complex phenomenon |
| Normal Aging Changes | -Aging process is deleterious (diminish function) -Progressive, occur gradually -Intrinsic, not modifiable -Universal, affects all in the species - Irreversible -Genetically programmed - most difficult for people to deal with |
| Aging:Definition | -Assumes a process -slow/ happens over a time -Diminishes function |
| Senescence | -Progressive determination -Increasing vulnerability |
| Lifespan | -Maximum survival potential -About 115 years for human |
| Life Expectancy | Predictable length of time expected to live |
| Biological Theories of Aging | 1 Genetic 2 Wear and Tear 3 Cross-Linkage 4 Lipofuscin/ Free radicals 5 Neuroendocrine 6 Apoptosis 7 Longetivity |
| Genetic Theory | -Everything that happens with the body -Predetermined by genes |
| Wear and Tear | -Cells just become tired -Body wears out |
| Cross-Linkage | -Things meet in time -Moment in time that changes life |
| Lipofuscin/ Free Radicals | -Chemical compounds body produces when certain actions happen -Breakdown processes = negative effects |
| Neuroendocrine | -Brain, nerves, glands -Changes in nervous system in how they tell glands what to do -Nerves - long, prone to injury |
| Apoptosis | -Normal process of cells -More cells die than are replaced -Apoptosis can go awry |
| Longevity | -Structured lifespan -Try to predict when death will occur |
| Psychological Theories | 1 Human Needs 2 Life Course |
| Human Needs Theory | -Maslow -Psychological, safety, love, self-esteem, self-actualization - Steps must meet lower level before moving to the next one |
| Life-Course Theory | Personality is predictive of the aging process |
| Sociological Theories | 1 Disengagement 2 Activity 3 Continuity 4 Subculture |
| Disengagement Theory | Social involvement decreases with age leading to aging |
| Activity Theory | Physical and social activity leads to engagement with life |
| Continuity Theory | Keeping things the same leads to less disease and aging |
| Subculture Theory | Elders have their own norms, beliefs, habits, leading to less engagement with society |
| Relevance of Biological Aging | Primary (biological) Aging- Changes occurring with age independent of disease of environmental changes Secondary (environmental) Aging - Changes involving interaction of primary aging with disease processes and the environment |
| General Aging Changes | -Fewer functional cells int he body -Reduction in intracellular fluid -Loss of subcutaneous fat (flabby) -Lower oral temperatures -Stature decreases - Loss of cartilage; thinning of vertebrae |
| Variations in Diagnostic Tests | -Sedimentation Rate-More cells settle -Glucose-Higher -Creatinine -Albumin-body healing decreases -Alkaline Phosphatase-elevated levels -Urinalysis-in elderly there may be cells, blood, clots -Chest X-ray -EKG-pulse increase, irregular beats |
| System Based Changes | -Cardiovascular -Neurological -Respiratory -Genitourinary -Endocrine/Metabolic -Musculoskeletal -Autonomic Nervous system -Hematologic -Immune -Oral -Sensory -Dermatologic -Reproductive |
| Immune Function | -Size of the thymus gland decreases -T-cell function declines -Decreases in cell-mediated immunity -Chronic conditions have ability to decrease immune function -Exposure to pathogen |
| Increased Risk of Infection | -UTI - common in women -Prostatitis - men -Pneumonia -TB -Vaginitis - women -Herpes Zoster - Shingles - Best to get shot |
| Health Promotion | -Add life to their years -Healthy people 2020 - Federally funded program to target certain populations - Plan to get people healtheir |
| Screening Programs | -Need for early diagnosis and treatment -Colon Cancer test |
| Risk Reduction | -Chronic Disease - Diabetes - Look @ feet - Start treatment early -Mental Health - Social Engagement -Infectious Disease -Immunizations - Easy and Free |
| Environmental Modifications | -Safety measures in any living arrangement - No area rugs; grab bar in BR; lock doors and window -Prevention of injury -Sensory system involvement related to changes of aging |
| Health Related Behaviors | -Physical Activity -Nutrition -Programs for ppl with limited or no resources -Provide meals @ homes |
| Fulmer SPICES | S - Sleeping Disorder P - Problems with eating I - Incontinence C - Confusion E - Evidence of falls S - Skin Breakdown |
| Purpose of Acute Care | -Hospital - Stabilize patients with life threatening disorders - Needed when procedures are necessary - Requirement of 24 hour nursing care |
| Who is Admitted | -Acute exacerbation of a chronic condition -An Acute new condition -Older ppl are admitted 2X as often -Older adults stay 2X longer -Those admitted are sicker, have more illness,fewer social supports, mental impairment -Problem lists can be quite lo |
| Course and Outcome of Hospitalization | -Depends on comorbidity or health complications -Older adults have higher mortality rates than younger patients |
| Functional Status | -Consider aging physiology -Chronic conditions = possible functional impairments and older adults who are hospitalized are more likely to experience functional impairments so we need to identify changes quickly to minimize further disability |
| Impact of Hospitalization | -Maybe be final event -Can cause increased dependency needs and possible permanent impairment as soon as the 2nd day of admission -Impact of complications - adverse drug reactions,confusion,bladder and resp. infections, falls, incontinence |
| Nosocomial Infections | -Acquired in the hospital -Are often antibiotic resistance -MRSA/VRE -Bad bugs in the hosp. -Elderly are quite vulnerable r/t decreased immune response |
| Iatrogenic Infection | -Nosocomial infection that results from a diagnostic test/procedure -Bladder infection after foley inset -Prolonged immobilization -Dehydration |
| Emotional Reaction to Hospitalization | -Anxiety -Depression -Agitation -Disorientation -All can lead to falls and other injuries |
| Key concepts of Care | -Altered Homeostasis -Impact of the Hospital Environment -not like home -Potential Ethical Conflicts -Need for the nurse to be a patient advocate -Always have the option to "do nothing" |
| Risks of being Hospitalized | -Delirium - falls -Infections -Immobility - Pressure Ulcers -Fluid and electrolyte imbalance -Dehydration -lose thirst drive -Incontinence -Constipation -Loss of functional Independence |
| The Cascade to dependency | -Normal aging changes = decline in function -Vasomotor instability - Syncope -Fainting spells, dizziness,falls -Loss of plasma = postural hypotension and syncope -Deconditioning/ loss of function -Need for nursing home placement |
| Hazards of Bedrest | -Muscle mass and strength are reduced -5% per day -Limited ROM and contracture (permanently contracted) -Sensory continence - confused by environment -Sensory deprivation |
| Complications of Disease | -Resp.-Decrease PO2, closing volume of the alveoli -Demineralization-loss of bone = normal -Urinary Incontinence -bladder capacity reduced -Thirst & Nutrition-loss of taste,smell and add dentures - |
| Interventions | -Thorough assessment -Encourage Independence -Frequent safety checks -Orient routines of hosp. -Supportive environment -Explain procedures -Monitor Meds -Reposition -Monitor I&O -Anticipate common problems -Help with ADLs -Education -Discharg |
| Surgery | -Benefits -Can add more functional years to person's life -Risks -Mortality higher -Lung disease - anesthesia -Vascular disease - blood clots -Potential for infection and hemorrhage -Often more risks than benefits |
| Perioperative Nursing | Identify current disease, decreased organ function, labs, meds, mobility, nutrition, management of medical condidtions -Get them to surgery in the best condition possibly |
| Intraoperative Nursing | -Careful monitoring, anesthesia chosen, depression of cardiovascular/resp systems, slower elimination of the drug from the body, safety/sterile environment, proper positioning, monitor VS esp temp, warm IV fluids, warm blanket |
| Nursing Care during an emergency situation | -Acute Abdomen -Acute confusion/Delirium -Aspiration -Corneal Abrasion -Dehydration -Detached Retina -Diarrhea -Falls -MI -Hemorrhage -Postoperative Complications |
| Necessity of Early Discharge | -Begins on admission -Discharged sicker and quicker -Continuity of care -Patient, family, MD, nurses -Benefits -Get home to recover in own environment -Identification of patient needs -Caregiver Needs |
| Comprehensive Assessment | -Identify pasts as well as current problems -Symptoms -Physical -Functional Status -Health Promotion -Nutrition -Social -Mental -Environment/Living -Family Availability -of Caregivers |
| Age and Function | -May not be related -Consider functional status without considering chronological age -Consider disease states and their effect on functional status |
| Distinguish Normal from pathological | -Consider past behavior and functional status -Also think about issues related to race, gender, education |
| Make the assessment brief | -Evaluate for fatigue -Assess the most important issues first -Consider caregiver input -Consider the environment |
| Multiple methods of assessment are essential | -Self-report -Patient usually most accurate -Evaluation of performance |
| Long Term Care (LTC) | -Nursing Home/Nursing Facility -Extended care Facility - > a couple of days -Skilled Nursing Facility -Need RN 24hrs a day -Intermediate Nursing Facility -For someone a little confused -Assisted Living -Special Care Unit -Specially train |
| Roles of Nurse in LTC | -Nursing care is foundation of ECF -Understanding the special needs of elders is vital -NPs can provide -Advanced assessment -Home visits -Staff education |
| Community Based Services | -Mobile Meals -Home Health Aid - Basic skills -Homemaker,Companion - clean, meals -Senior Centers - provide meals -Personal Emergency Response - -Adult Day Care - Services, activities, food -Parish Nurse - volunteer, maintain health in that parish |
| Role of Nurse in Community | -Develop local services -Help with screenings -Home Care Coordinator -Meet specific cultural needs of a population |
| Chronic Illness and Elderly | -More people are reaching old age -Increase in chronic disease -Physical/Emotional/Social Implications -Major chronic conditions |
| Common Chronic Conditions | -Arthritis -Most common -Diabetes -Type 2 Diabetes - overweight -Heart Conditions -Hearing Impairments -Hypertension -Cataracts -Elimination Problems -Bladder/Bowel control |
| Chronic Care Goals | -Maintain/improve self-care capacity -Manage the disease effectively -Boost the body's healing abilities -Prevent Complications -Delay deterioration and decline -Achieve the highest possible quality of life -Die with comfort and dignity |
| Functional Assessment | -Heterogeneous group -ADL-Activities of Daily Living -Bathing,dressing,eating,mobility -IADL-Intrumentals ADLs -Shopping,meal prep,manage$ -Most important in community setting |
| Identifying Driving Risk | -Decrease field of vision -Driving at inappropriate speeds -Getting lost -Slow reactions -Not noticing traffic signs -Miscalculating distance -Difficulty focusing attention -Difficult nighttime driving |
| Addressing Driving Risk | -Watch for drug interactions -Assess vision and hearing -Refer for PT,OT -Pedal extenders -Spinner knobs on steering wheel' -monitoring of other cars during lane changes -Spot mirrors -Mature Driving Programs |
| Common Hearing Issues | -Presbycusis - high pitched hearing loss; age related change NOT illness -High pitched consonant sounds are at the first affected -Gradual process |
| Age-Related changes that affect hearing | -External Ear - Pinna & Ear Canal -Cerumen(ear wax) -cleanses, protects, lubricates -Builds up due to hair growth & keratin buildup = Can affect hearing -Hair Follicles -Start to overgrow and affect hearing -Fewer sweat glands in the external e |
| Middle Ear | -Air Filled -Tympanic Membrane -Transmits sound energy to the middle/inner ear -Ossicles-Malleus,incus,stapes, amplify sound -Bones become calcified -Muscles & Ligaments -Contract in response to loud noise -Muscles become weaker |
| Inner Ear | -Fluid Filled -Cochlea- receives sound vibrations and concert to nerve impulses in vestibular nerve -Loss of hair cells in Organ of Corti, reduced O2, less endolymph, loss of neurons leads to hearing loss termed presbycusis |
| Environmental Factors: Hearing Loss | -Exposure to loud noises -Farmers,Musicians -Exposure to toxic chemicals -Solvents, pesticides,herbicides -Leisure activities -Hunting, woodworking -Smoking -Impacted Cerum |
| Medication Effect on Hearing | -Damage the cochlea or vestibular part of auditory nerve -Quinine(Malaria); Salicytates (Aspirin); Turosemide (water pill) -Toxic effects are generally dose related |
| Disease Processes Affecting Hearing | -Otosclerosis - hereditary disease of ossicles/ generally conductive hearing loss -Meniere's Disease -Balance and Hearing -Acoustic neuroma -benign tumor -Tinnitus -buzzing noise that doesn't originate in external environment -No diagnostic test |
| Effect on Communication | -Vowel sounds = low pitched -Consonants = high pitched -p,,b,d,t sound similar & distorted -ch,f,sh,t,th-whistling quality and distorted -Background noise cause greater hearing difficulty -Hearing aids amplify sound also amplify background noise |
| Interventions for Hearing Loss | -Hearing aids -Megaphone, Microphone -Closed captioning TV -Assisstive Hearing devices -Troublesome if not individualized |
| How to Communicate | -Face the person -Gain their attention -Speak distinctly, slow & directly -Don't exaggerate lip movements -Don't chew gum, turn away, cover mouth -Eliminate Background noise -Don't raise volume -Lower pitch -Use gestures |
| Potential Nursing Diagnoses | -Sensory-Perceptual Alteration -Social Isolation -Risk of Injury -Ineffective coping -Body Image Disturbance -Altered Role Performance -Self-Care Deficit -Impaired Physical Mobility -Ineffective Coping -Risk for Loneliness -Body Image Disturbanc |
| Visible Age-Related Changes | -Arcus Senillis -Lipid accum. in outer part of the cornea with yellow ring developing b/w the iris and the sclera -Dulling of Cornea -Yellowing of Sclera -Fading of iris -Enophthalmos - loss of orbital fat, wrinkles,less elastic eye muscles -Look s |
| Blepharochalasis | -Upper lip impairs vision |
| Corneal Changes | -Becomes opaque and yellow -Interferes with the passage of light to the retina -Scatters light causing blurring -These are not risk factors, they are age-related changes |
| Lens Changes | -Layers of clear crystalline protein -Eye muscles change shape to accommodate near and far object -Regenerates & forms layers causing buildup -Lens gets stiffer and less accommodateable -Becomes more opaque -Difficulty distinguishing blue and green c |
| Iris Age-Related Changes | -Controls pupil size regulating light reaching the retina -Becomes more sclerotic and rigid reducing the size for the pupil -Slower response to changes in light-changes in the iris/pupil -Increased sensitivity to glare |
| Other Vision Changes | -Narrowing of the visual field -Diminished depth perception -Slower processing of visual information -Retinal-Neural Pathway -DISEASE makes these changes worsen |
| Cataracts | -Opacity of one or both lenses -Leading causes of visual disability -Reversible -Risk factors -Family History -Diabetes Mellitus |
| Signs and Symptoms: Cataracts | -Increased problems with glare and night driving -Gradually decreasing acuity -Altered color perception -Darkening/dimming of vision -Blurred Vision -"film over eyes" -HA -Eye Fatigue |
| Interventions: Cataracts | -Conservative - eye drops -Cataract extraction surgery -Intracapsular - take out lens -Extracapsular - take out capsule and lens; can't replace lens -Intraocular - lens inserted -Eyeglasses needed for near vision |
| Age-Related Macular Degeneration | -Leading cause of blindness -Dry Type -Caused by death of photo receptor -Progress slowly -Not total blindness -Wet Type -Damage caused by new blood vessels forming on choroid then hemorrhage under retina -Progress rapidly -Severe vision los |
| Signs and Symptoms:Macular Degeneration | -Usually bilateral central vision loss -Blurred and distorted vision -Significant interference with visual skills necessary for reading,driving,watching tv, recognizing people, and performing ADLs and IADLs |
| Interventions: Macular Degeneration | -Magnifiers -Low-vision aids - large print books -Use of side (peripheral) vision -Look at wall instead of TV -Referral for early treatment with laser photocoagulation -May be effective for some |
| Glaucoma | -Defect in the outflow of aqueous humor, resulting in increased intraocular pressure that destroys the retina -Risk Factors -Family History -Race-African American -No visual loss/pain in early stages |
| Glaucoma: Types | -Open Angle (Primary/Chronic) -Most common, slow onset, progressive, loss of peripheral vision (tunnel vision), intact central vision -Closed Angle (Acute) -Less common, very painful, abrupt onset, blurred vision, colored halos around light |
| Glaucoma: Assessment | -History of Symptoms -Visual Field of Examinations -Measurement of Intraocular Pressure -Findings from Fundoscopy |
| Open-Angle Glaucoma: Interventions | -Pharmacological -Miotic eye drops (pilocarpine) -Constrict pupil -Beta Adrenergic Blockers (Timolol) -Carbonic Anhydrase Inhibitors (diamox) -Target fluid in eye -Epinephrine -Decrease size of pupil |
| Closed-Angle Glaucoma: Interventions | -Occurs quickly and causes damage quickly -Referral for surgery -Pharmacological -eye drops -diamox IV |
| Poor Vision: Light | -Elderly need 3x more light -Avoid glossy paper -Must have night lights |
| Poor Vision: Dry Eye | -Avoid hair sprays and smoke |
| Poor Vision: Color Contrast | -Most dangerous -Need different colored knobs on oven -Cutting Boards -Onion on black board -Pepper on white board -Decorations on table determine height of object |
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