Nursing Gerentology
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| Gerentology | study of the process of aging and problems of aged people
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| Gerontologic Nursing | Concerned with the assessment of health and functionality, status of older adults, planning and implementing services to meet the needs of older adults
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| Geriatrics | branch of medicine that deals with disease and problems of old age
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| Most common problems of elderly | coronary artery disease, sinusitis, diabetes mellitus, heart disease, hypertension, arthritis, hearing impairment, orthopedic problems, cataracts, tinnitus
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| young elderly | 65-74
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| elderly | 75-84
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| frail elderly | 85 and older
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| home care | client must have a skilled need for insurance to pay. largest portion of home health agency clients are older adults
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| retirement homes | geared toward the elderly that need a continuum of care
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| rehabilitation facilities | facilities geared to improving functional status.
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| adult day care | community based programs as an alternative to institutionalization
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| assisted living | facilities for patients who need some assistance but are able to maintain a degree of independence and still live in their own apartment. Most expensive
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| Long term care | patients need around the clock care, professional nurse always present, subject to rigid regulations
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| continuing care facilities | have accomodations for independent living, assisted living and long term care, very expensive
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| Medicare | fed funded insurance for those 65 or older
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| managed medicare | medicare managed by a private insurance co.
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| medicaid | state admin program for low income persons. nursing homes must take a certain number of medicaid patients.
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| type A medicare | hospitalization, hospice, skilled nursing available to all. does not include assisted living and rehab. Skilled nursing care only
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| Medicare part B | supplemental to medicare
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| medigap | AARP and BC & BS for example. costs vary
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| Number 1 reason for admission to assisted living? | incontinence
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| Possible signs of UTI in elderly | incontinence, confusion, anorexia, dysuria absent (frequently), change in mental status
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| Possible signs of MI in elderly | possibly no chest pain or pain in atypical location, shortness of breath, dysryhtmia, tachypnea, hypotension
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| Possible signs of pneumonia in elderly | confusion, anorexia, nausea, vomiting, tachycardia. may not have elevated WBC or productive cough
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| Possible signs of hypothyroidism in elderly | slowing down, CHF, lethargy, weakness, depression, afib
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| Considerations when performing health assessment for the older adult | adequate space, minimum noise and distraction, sit/stand in full view, comfortable temp, diffuse lighting, no glares or glossy surfaces, accept slower response times are possible, perform during peak energy time
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| ADL's (activities of daily living) | bathing, dressing, toileting, transfer, continence, mobility
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| Instrumental ADL's | telephone usage, shopping, food prep, housekeeping, laundry, transportation, meds, finances.
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| mini mental exam | orientation, registration, attention, recall, language
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| Orientation | person, place , time
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| registration | recent memory, ie. ask to repeat 3 object previously mentioned
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| attention | spell world backwards, count backwards from 100 by sevens
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| recall | remote memory
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| language | id two objects and ask for names of them, repeat "no if, ands, or buts.3 stage commands
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| depression in elderly | usually temporary, can be treated, rapid onset, self neglect, anhedonia, significant relationship between depression and memory making diagnosis difficult
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| physical signs of depression | fatigue, anorexia, constipation, confusion, lethargy, disinterest, change in sleep pattern
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| delerium | temporary, rapid onset, brief in length, disturbance in consciousness along with rapid change in cognition, disorientation,impaired memory, very agitated, usually specific cause can be identified
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| causes of delerium | opiates, change in environment, head injury, tumor, pain, stress, metabolic disorder, hypoxia, other meds
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| dementia | syndrome of progressive decline that erodes intellectual abilities causing cognition and functional deterioration
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| types of dementia | alzheimers disease, vascular dementia, parkinsons, Mild cognitive impairment (MCI)
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| Alzheimers disease | number one cause of dementia, progressive degeneration and death of brain cells. brain pathways destroyed and shrunken. results in problems in thinking, memory and behaviour.
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| vascular dementia | presents like alzheimers, stepwise decline due to mini strokes. Initial symptom not memory loss
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| parkinsons disease | neurogenerative disorder, degeneration of synapse, resting tremor, bradykinesia, rigidity.
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| Alzheimers disease pathophysiology | amyloid protein leads to neurofibrillary pathology and cell death. tau protein forms tangles, normal cells are crowded out and die, dead cells decrease neurotransmitters such as acetylcholine.
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| Warning signs of Alzheimers disease | memory loss affects job skills, difficulty performing tasks, problem w/language & word finding, disorientation to time & place, poor judgment, difficulty w/ abstractions, misplacing things & blaming others, mood change , loss of executive skills,
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| Differential Diagnosis D.E.M.E.N.T.I.A | D-drugs, E-emotional (depression), M-metabolic (thyroid-hyper and hypo), E- eye, ear disorders, N-nutritional, T-tumor, trauma, I- infection, A- artheroschlerosis decreases circulation to brain
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| Stages of AD | early, middle, late
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| Early Stage of Alzheimers | repetition, misplacement of items, unable to pay bills, unkempt, difficulty with meds, difficulty with simple arithmetic, communication wanes, loss of executive functions
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| Middle Stage of Alzheimers | unaware of very recent events, cannot learn, difficulty with choices, needs detailed instruction for simple tasks, decrease in coordination and balance, self absorbed, delusions or hallucinations, incontinence
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| Late Stage of Alzheimers | no recent or remote memory, little cognitive function, unable to swallow, cannot recognize primary caregiver, agitation
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| Common Alzheimers Meds | Tacrine (cognex), Donepezil(Aricept)- most common, Revastigmine(Exelon), Memantine (Namenda)- becoming more popular, Galantamine (Reminyl)
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| SDAT | Senile Dementia of the Alzheimers Type
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