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Gero test 1
| Question | Answer |
|---|---|
| Aging? | Process that begins with birth, so applies to young and old |
| Functional age vs. chonological age | Functional age is based on what a person can and cannot do Chronological age is based on how many years you have lived Functional age is more useful |
| Ageism | Making conclusions based on a person's physical appearance |
| Multiple Jeopardy | Discrimination based on various attributes ( ages, sex, race) 86 yr, female, hispanic (FUCKED) |
| Implicit ageism | Thoughts, feelings, and behaviors toward elderly without conscious awareness of it. Negative feelings are triggered merely by seeing an elder. Feeling annoyed w/ elder w/o realizing you are doing it. |
| Retirement, Role changes, life review, widowhood, fixed income, health changes are examples of what? | Life changes with Age |
| Nursing Models to Promote wellness in Older Adults | Focus on adding life to years, not just years to life. Living a better life, not always a longer life. |
| Physiologic processes that increase the vulnerability of older people to the negative impact of risk factors are called..? (vision and hearing loss, etc.) | Age related changes (unchangeable and inevitable) |
| Have significant detrimental effect on health and functioning | Risk factors |
| Major Risk factors | Smoking, obesity, inadequate exercise, progressive arthritis, increased effects of glare, background noise. |
| 1.) Quality of Care | 1.) Nurse systematically eval. the quality of care and effectiveness of nursing practice |
| 2.) Performance appraisal | Gero. nurse eval. his or her own nursing practice in relation to others |
| 3.) Education | Nurese acquire and maintain current knowledge applicable to nursing |
| 4.) Collegiality | Nurse contributes to professional development of peers, colleagues, and others |
| 5.) Ethics | Nurse's decisions and actions on behalf of older adults are determined in an ethical manner |
| 6.) Collaboration | Nurse collaborates w/ older adult, older adults caregivers, and all members of the multidisciplinary team to provide comprehensive care. |
| 7.) Research | Nurse interprets, applies, and evaluates research findings to inform and improve practice |
| 8.) Resource utilization | Nurse considers factors related to safety, effectiveness, and cost in planning and delivering patient care. |
| Screening programs include: | Annual BP check, serum cholesterol (5 years), Fecal occult blood and rectal exam (annually), Sigmoidoscopy (3 to 5 years), visual acuity and glaucoma screening (annually), Breast/ testicular exam (self and annual screening) |
| Aging causes decreases in function (deleterious), it is a gradually progressive process. It is intrinsic (non modifiable), and occurs in all species and to everyone. It is an irreversible process and is genetically programmed. | |
| Aging is... | A process that happens over time and results in a decrease of function |
| Senescence is... | Progressive deterioration, increasing vulnerability. |
| Lifespan.. | Maximum survival potential (longest possible length of time a person can live) |
| Life expectancy.. | Predictable length of time someone is expected to live (based on many factors) |
| Genetic: Biological theory of aging (BTA) | -everything is predetermined by our genes and unchangeable |
| Wear and tear (BTA) | Cells get tired, wear out and are no longer functional |
| Cross-linkage (BTA) | Opportunities that happen and change life progression |
| Free radicals (BTA) | Particles produced through bodily processes that damage other bodily functions. |
| Neuroedocrine (BTA) | Connections b/n neurons and glands become faulty and fail to regulate the endocrine system |
| Apoptosis (BTA) | Programmed cell death, eventually more cells die than are created |
| Psychological theories of aging Human needs (safety, love, self esteem, self-actualization) | If you do not progress through lower stages of psychological development, it leads to increase aging. |
| Disengagement Sociological theories of aging (STA) | Social involvement decreases with age leading to aging |
| Activity (STA) | physical and social activity leads to engagement with life |
| Continuity STA | keeping things the same leads to less disease and aging |
| Subculture STA | Elders have their own norms, beliefs, habits, leading to less engagement with society |
| Primary Aging.. | Changes occurring independent of disease or environmental changes (not connected to how/ where I live, occurs to everyone absent from outside influence. |
| Secondary Aging.. | Changes involving interaction of primary aging with disease processes and the environment (influenced by outside factors: drugs, smoking, travel, disease) |
| Fewer functional cells in the body, reduction in intracellular fluid (dehydration), loss of subcutaneous fat (loose skin), lower oral temperature, Stature decreases ( loss of cartilage, thinning of vertebrea) | Normal Age changes |
| glucose levels ___ with age? | Increase with age |
| Sedimentation rate____ with age? | Increases with age |
| Albumin____ with age? | Decreases with aging causing delayed healing |
| Alkaline phosphate___with age? | Increases with age |
| Urinalysis changes with age? | Cells and blood are found in urine that would be abnormal in a young person, but is normal in old age. |
| EKG___with age? | HR increases with age, and irregular beats become more common. |
| Normal age related decline of Immune function | Size of thymus decreases (atrophy), T-cell function declines, cell-mediate immunity decreases, Chronic conditions adversely effect immune function. |
| UTI, prostatisis, pneumonia, TB, vaginitis, Herpers zoster (shingles) become more prevalent in older age | |
| The goal of health aging of an Older adult is... | Adding LIFE to years, and not YEARS to life.. Quality of life not quantity of life |
| Screening programs help catch diseases early when they are easier to deal with, or even can lead to treatment that prevents full onset of the disease | Ex. Colon cancer screening (occut blood in stool) |
| Risk reduction include: | Treating chronic conditions, Encouraging social interaction, managing and preventing infectious diseases, administer immunizations |
| Environmental Modifications: safety measures in any living arrangement (lock doors, check windows) Prevent injury (remove area rugs, instal grab bars in bathroom etc.) Sensory system involvement related to changes in aging ( night lights, etc) | |
| Health Related Behaviors: Physical activity (encourage elder to stay active) Nutrition: stress the importance of eating a healthy well balanced diet | Water aerobics are beneficial for elderly if they joint issues or issues with mobility Educate elder about how to eat healthy and find them resources so that they can obtain healthy foods |
| Evaluation of elderly (Fulmer SPICES) | S-sleeping disorders P-problems with eating I- incontinence C-confusion E-evidence of falls S-skin breakdown |
| Purpose of Acute care is to....? It is needed when procedures are necessary and usually requires 24 hour nursing care | Stabilize patients with life threatening disorders |
| Who is admitted? | Patients with exacerbation of a chronic condition " with acute new conditions |
| Older people are admitted___ as often as younger adults? Older adults stay___as long as younger adults? Older adults admitted are sicker, have more illnesses, fewer social support, and have mental impairment Usually have large amount of issues | twice as often |
| Comorbid means? | other health problems that contribute to current illness |
| Functional status is a better judge of a person physically than chronological age | Don't look at how old someone is chronologically, look at their functional age. What they can and cannot do? |
| Hospitalization may be the final even of a frail older adult. | |
| Can cause increased dependency needs and possible permanent impairment as soon as ____ day of admission | second day of admission |
| Major problems for older adults who are hospitalized are? | Adverse drug reactions, bladder and respiratory infections, increased risk of falls, incontinence |
| Nosicomial infections | Acquired in the hospital, often caused by antibiotic resistance (MRSA/VRE) |
| Iatrogeni infections | Nosocomial infection that results from a diagnostic test/procedure (bladder infection after catheter, prolonged immobilization, dehydration) |
| Emotional reaction to hospitalization | Causes anxiety, depression, agitation, disorientation (all of these factors lead to falls and other injuries) |
| Risks to older adults who are hospitalized...? | Delirium (leads to falls), Infections (decreased immune system), Immobility (bed sores), Fluid and electrolyte imbalances, dehydration, incontinence, constipation, loss of functional independence |
| The Cascade to Dependency Normal aging changes lead to decline in function (body systems wear out) | Vasomotor instability (low BP) leads to snycope (fainting spells) Caused by age related decline in body water and plasma volume and bed rest results in loss of plasma leading to hypotension |
| Hazards of bedrest for elderly include: | Muscle strength decreases by 5% daily leads to limited ROM, contractures, Sensory continence: increased risk of confusion resulting from reduction in sensory input, and hearing and vision impairment |
| Contracture | Permanent contraction of a muscle resulting from not using muscles |
| Interventions to prevent complications related to hospitalization include: | 1.) Assessment and knowledge of potential dif. 2.) Encourage independence 3.) Frequent safety checks/visit patient 4.) Orient patient to hospital routines 5.) Provide supportive enviroment 6.)Explain tests and procedures (what is going to occur) |
| Interventions to prevent complications cont. | 7.) Close monitoring of meds 8.) Reminders to turn, reposition, cough, deep breath 9.) monitor I&O, mental status, nutritional status 10.) Anticipate common problems (falls/missed meals/incontinence) 11.) Assit with ADL's while promoting self-care |
| Interventions cont. | 12.) Educate patient and family 13.) Start discharge planning upon admission |
| Surgery and the Older adult Benefits: May add functional years to persons life Risks: Mortality higher, lung disease (due to anesthesia), vascular disease (blood clots, BP fluctuations), potential for hemorrhage or infection | |
| Necessity of early discharge planning measures Begins on admission: Continuity of care: Benefits: Identification of patient needs: Caregiver needs: | -patients are discharged sicker and quicker -Patient, family, MD, nurses -Get home to recover in own environment -Each person will be different (need walkers, cane, etc.) -What do they need to provide adequate care |
| Comprehensive assessment is essential: | -Identify past as well as current problems (important because of comorbid complications) -Assess symptoms (what makes it worse?) -Physical assessment (ask about previous surgery) -Functional assessment -Health promotion activities |
| Assessment cont. | -assessment of nutritional status -Social Evaluation (what social supports do they have: family, friends, etc.) -Mental status exam -Enviro. assessment/living arrangements -family availability -Assessment of caregivers (what support can they provide |
| Age and function may not be related | Consider functional status w/o considering chrono. 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, etc... |
| Make Assessment brief | Evaluate for fatigue Assess for most important issues Consider caregiver input Consider the environment |
| Methods of Assessment include: | Self-report (best and most accurate) Evaluation of performance |
| Long Term Care (LTC) -Nursing homes -Extended care Facility -Skilled nursing facility -Intermediate Nursing facility -Assisted living -Special care units | -ECF (stay is longer than a few days) -SNF (requires RN on staff at all times) -INF (step down from SNF) -Aliving (patient is mostly self reliant, provide minimal care Special care unit (dementia unit: special training to deal with patients is require |
| Community Based Services include: -Mobile meals -Home health aide -Homemaker, companion -Senior center -Personal Emergency Response -Adult Day care -Parish nurse | -Meals delivered to homes -Trained to provide baths and basic assessment -provide company to patient, clean, cook -Provide meals, coupons, activities -day care: designed for forgetful persons |
| Role of Nurses in the Community | -Develop local services -Help with screenings -Home care coordinator -Meet specific cultural needs of a population |
| Effects Chronic disease has on.. Physical Emotional Social | -Impact the changes on various body systems -effect self-esteem, anxiety, depression -isolation |
| Common Chronic Conditions include: | Arthritis (most common) Heart conditions (high BP) Hearing impairment Hypertension Cataracts Diabetes (blood glucose rises with age) Elimination problems |
| Healing does not always mean to cure: -learning to live with the disease | Implies the mobilization of the body, mind, and spirit to control symptoms, promote a sense of well being, and enhance the quality of life |
| Chronic Care goals Nurses role in the healing process? | 1.) Maintain or improve self-care capacity (what has changed now that the person has the disease) 2.) Manage the disease effectively ( teach patient about disease) 3.) Boost the body's healing abilities 4.) Prevent complications (minimize risks) |
| Chronic care goals cont. | 5.) Delay Deterioration and decline (early identification of problems) 6.) Achieve highest possible quality of Life 7.) Die with comfort and dignity |
| ADL (Activities of Daily Living): | Bathing, dressing, eating, mobility |
| IADL (Instrumental ADL's) | Shopping, meal prep, managing money |
| Identify Driving Risk | -loss of peripheral vision -Driving at inappropriate speeds -Getting lost -Slow reactions -Not noticing traffic signs -Loss of depth perception -Difficulty focusing -Difficult nighttime driving |
| Presbycusis | Loss of High pitched sounds (consonants) |
| Age-related changes that affect hearing External ear (Pinna and Ear Canal) Cerumen (cleanses, protects, and lubricates) Fewer sweat glands Cerumen buildup | -Floppy and less firm -builds up due to hair growth, keratin build up (firmer ear wax) |
| Middle Ear (air filled) Tympanic membrane: transmits sound energy to the middle ear and inner ear Ossicles: malleus, incus, stapes (amplify sound) Muscles and ligaments (contract in response to loud noise) | -collagen replaces elastic tissue causing it to stiffen and conduct less sound -bones become calcified (less conductive) -Muscles become weaker |
| Inner ear (fluid filled) Cochlea: receives sound vibrations and converts it to nerve impulses in vestibular nerve | Loss of hair cells in Organ of Corti, reduced O2, less endolymph, loss of neurons lead to hearing loss termed presbycusis 4 types |
| Sensory presbycusis: | Degenerative changes of the hair cells and the organ of Corti in the chochlea (sharp hearing loss at high fequency) |
| Neural Pres: | Caused by widespread degeneration of the nerve fibers in the cochlea and spiral ganglion (reduced speech discrimination) |
| Metabolic or strial pres: | Degenerative changes in the stria vascularis and a subsequent interruption in essential nutrient supply. (initially reduce sensitivity to all sound frequencies then interfere with speech discrim.) |
| Mechanical pres: | Mechanical changes in the inner ear structures and is characterized by a hearing loss that initially involves lower frequencies and gradually spreads to hight frequencies. |
| Environmental factors that lead to hearing loss | Exposure to loud noises (farmers, musicians) Exposure to toxic chemicals (solvents, pesticides, herbicides) Leisure activities (hunting, woodworking) Smoking Impacted cerumen (dry environments) |
| Medication effect on Hearing | Damage to cochlea or vestibular part of auditory nerve (aspirin, diuertics) |
| Disease processes affecting hearing | Otosclerosis (hereditary disease of ossicles~irreversible~) Meniere's disease (dizziness) Acoustic neuroma (tumor on acoustic nerve) Tinnitus (ringing, buzzing noise that does not originate in the external environment) |
| Use appropriate interview questions: | Do you have any trouble with your hearing? Have you noticed any change in your ability to understand conversations or hear words? Are you bothered by any noises in your ears, such as ringing or buzzing? |
| Interventions for hearing loss include: | Hearing aids Megaphone, microphone Closed captioning TV Assistive hearing devices: if not individualized (not useful) |
| Visible Age-related changes in the eyes: Blepharochalasis (eye lid droops) | Arcus senilis (lipid buildup in outer part of cornea b/n iris and sclera causing a yellow ring around the iris) Dulling of cornea (less translucent) Yellowing of sclera color of iris fades Endopthalmos: loss of orbital fat causes eyes to appear sunken |
| Corneal Changes | Becomes opaque and yellow interferes with passage of light to the retina and scattering of light leading to blurring These are age-related changes |
| Lens changes | Constantly adding layers to lens leads to it becoming stiff and less playable and unable to accommodate Becomes opaque and cloudy Difficulty distinguishing b/n blue and green arises |
| Iris age-related changes | Becomes sclerotic (stiff and rigid) reducing the size of the pupil and not allowing in adequate light Slower response to changes in light (may cause pain if light changes rapidly) Increased sensitivity to glare (hinders nighttime driving) |
| Other vision changes | Narrowing of the visual field (loss of peripheral vision) Diminished depth perception Slower visual processing due to faulty retinal-neural pathways DISEASE makes these changes worse |
| Cataracts Leading cause of visual disability It is reversible It is highly genetic, so look at family history | Clouding of the lenses (opacity) causes double imaging or blurring |
| Signs and symptoms of Cataracts include: | Increased problems with glare and night driving Gradually decreasing acuity Altered color perception Darkening of vision Blurred vision Headache and fatigue due to constant straining of eyes to see |
| Cataract interventions: Eye drops, or surgery | Intracapsular extraction (replace old lens) Extracapsular extraction Intraocular lens inserted Eyeglasses are needed for near vision |
| Age-related macular degeneration Leading cause of blindness Two types: Wet and Dry | Signs and symptoms of MD Bilateral vision loss (lose vision when looking directly at something) Blurred and distorted vision Significant interference with visual skills necessary for reading, driving, watching tv, recognizing people, and performing ADL |
| Two types of MD | Dry: (most common) caused by death of photoreceptors, progresses slowly, usually does not cause total blindness Wet: Caused by new blood vessels forming on the choroid, then hemorrhage under retina, progresses rapidly, severe vision loss |
| Interventions for MD | Magnifiers Low-vision aids Use peripheral vision early detection and treatment with photocoagulation Red colors easy to see |
| Glaucoma open angle (chronic) , and closed angle (acute) | Open angle (more common): slow onset and progressive loss of peripheral but central vision stay intact (tunnel vision) Closed angle (acute): very painful, abrupt onset: causes blurred vision and colored halos around lights. Requires emergency treatment |
| Interventions for Open-angle glaucoma Eye drops pupil constrictors Epinephrine | Interventions for Closed-angle glaucoma Requires surgery, eye drops and IV administered diamex may be minimally helpful |
Created by:
dbuhrman
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