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Gerontology 3 of 3

Adjustment for the family of a dementia pt can be enhanced by integrating the care of the family into the: nursing care plan
_____________ and ______________ add to the burden of families of dementia pts. Financial problems; multiple role responsibilities
Families of dementia pts should be encouraged to consider: adult daycare, or respite care if the elder resides at home
The most common form of dementia is: Alzheimer's Disease (70%)
Alzheimer's disease is the _____ leading cause of death in the elderly population. fourth
Alzheimer's is caused by a loss of neurons in the ___________ and __________ lobes of the brain, which control thinking and processing. frontal and temporal
Alzheimer's pts are unable to __________ and __________ new information as well as retrieve memory. process; integrate
Stage of Alzheimer's where there are mild short-term memory difficulties; difficulty learning new things; mild depression early stage
stage of Alzheimer's when the pt has increased short- or long-term memory loss; shows suspicion, agitation, hallucination; ADLs affected; wanders; incontinent middle stage
stage of Alzheimer's where pt shows severe memory impairment; impaired mobility; deteriorating speech; bedridden; weight loss; difficulty swallowing late stage
Treatment of Alzheimer's is primarily: symptomatic (symptoms are teated as they come up)
treatment for Alzheimer's that work by increasing acetylcholine in the cerebral cortex cholinesterase inhibitor drugs
cholinesterase inhibitor drugs tacrine (Cognex), donepezil (Aricept), galantamine (Reminyl), rivastigmine (Reminyl), rivastigmine (Exelon), Nameda
Other Alzheimer's drugs: indomethacin (Indocin), estrogen, vitamin E, folic acid, possibly cholesterol-lowering drugs
Nursing interventions for Alzheimer's: depend on stage of illness
behaviors associated with cognitive disorders: agitation/hostility/paranoia; usually preceded by increasing irritability; may have sudden explosive outburst; may be talking louder or pacing
Unusual behavior may also occur as a _____________ response to confusion, fear, or sensory loss. self-protective
Interventionsfor behaviors associated with congnitive disorders: engage the pt in conversation, maintain a safe distance, and maintain eye contact; move other pts or visitors out of the immediate area; use behavior modifications
Safety for the cognitively impaired - mild impairment patient may be able to stay in own home safely
Safety for the cognitively impaired - increasing impairment alerting systems attached to outside doors; identification shoud be sewn into clothes and placed in wallet or purse; measures to alert the household if the person leaves the bedroom at night; residential placement may be needed;driving may become an issue
People who wander because of cognitive disorders tend to be individuals who were: very ative people prior to the onset of the disease; wandering may be because of a need to combat boredom or restlessness
Nursing interventions for pts who wander: ensure the env. is safe for wandering; inform/educate others about the problem; make sure the pt has an id bracelet; frequently check the pt; observe for behaviors that trigger the wandering; divert the pt's attention; maintain a regular activity program
To help minimize nocturnal confusion: use a night-light; place the call bell within reach; reduce stimulation in the environment; move the pt closer to the nurses' station; protective devices (as a last resort because they might add to the pt's anxiety)
People with cognitive disorders often have eating problems. Common feeding challengs are: lack of appetite; refusal to open the mouth; holding food in the mouth; refusal to swallow food; choking when swallowing
Nursing Diagnosis for the cognitively impaired: anxiety, acute confusion, fear, impaired memory, disturbed thought processes, impaired verbal communication, self-care deficit, imbalanced nutrition: less than body requirements, impaired physical mobility, disturbed sleep pattern, fatigue, incontinence
More Nursing Diagnosis for the cognitively impaired: risk for injury, impaired social interaction, interrupted family processes, chronic low self-esteem, deficient diversional activity, risk for other-dircted violence, caregiver role strain, compromised family coping
often difficult to recognize because symptoms may be attributed to the aging process; often a result of factors such as multiple losses; undiagnosed and untreated, is a major contributor to alcoholism and suicide depression
Alcohol misuse is a __________ concern. It can interfere with the management of ______________. It also heightens the risk of adverse _____________ due to diminishing liver and kidney function. serious; chronic diseases; drug reactions
Interventions for depression, alcoholism, and suicide: tricyclics, antidepressents (MAOIs), selective serotonin reuptake inhibitors (SSRIs), electroconvulsive therapy, outpatient counseling or immediate crisis intervention
Any thougts or words of suicide must: take a priority and be reported.
S/S of depression: sleepy; low energy; staying home; decreased energy; lack of appetite
S/S of someone contemplating suicide: giving away their belongings, calling people to say goodbye
Assessment of Depression in Elderly pg. 855
most often inflicted by a spouse or adult children in the home, and is often undetected; often related to caregiver stress, unresolved family conflicts, or failies with a history or abuse elder abuse
Nursing responsibility for elder abuse: identify those at risk; assessment of s/s of suspected elder abuse (pg. 857); avoid a condescending tone of voice or judgmental expression; report suspected abuse to appropriate agency for investigation
Types of Abuse pg. 856
defined as failure to provide for the self because of a lack of ability or lack of awareness self neglect
Indicators of self neglect incldue: inability to: obtain adequate food and fluid; maintain ADLs (personal care, shopping, meal prep, household tasks); manage finances. Also: poor hygiene, changes in mental function, failure to keep appts; life threatening or suicidal acts
life threatening or suicidal acts can include: wandering, isolation or substance abuse
Even unintentional abuse is __________ to the elder. It is most likely to occur when the _________ lacks the knowledge, stamina or resources needed to care for an older loved one. devastating; caregiver
Stress for the caregiver builds, leaving them feeling: trapped, frustrated, or angry
any action that causes physical pain or injury physical abuse
Failure to provide food and fluids is considered: physical abuse
Most common form of abuse; it accounts for alost half of the verified cases of elder abuse neglect
passive form of abuse in which caregivers fail to provide for the needs of the older person under their care neglect
Examples of neglect: a bedridden person is left ___________ for long periods of time; an older person suffers from _________ because he or she lackes adequate clothing; failure to provide medical ________. wet and soiled; exposure; care
includes behaviors such as isolating, ignoring, or depersonalizig older adults; may be verbal or non-verbal emotional abuse
Repeatedly ignoring what the older person has to say or avoiding social interaction with the individual are _________ forms of abuse. subtle
occurs whendependent older person are deserted by the person or persons responsible for their care under circumstances in whih a reasonable person would continue to provide care. abandonment
It is natural to think that the older person suffering from one or more forms of abuse would ________, but this is rarely the case. _______ of being treated even worse or fear of being ______________ may prevent the victim from seeking help. complain; fear; institutionalized or abandoned
Information related to the client must be kept: confidential
All observations, both objective and subjective, must be carefully ____________. documented (in case legal action is required)
Detailed _________ should be kept. records
Abusive behavior in health care settings: use of sedative or hypnotic drugs that aren't medically necessary; ue or misuse of restrains when not medically indicated; use of derogatory language, angry verbal interactions or ethnic slurs; withholding priveleges such as snacks or cigarettes
More abusive behavior in health care settings: excessive roughness in handling during care or during transfers; delay in taking a resident to the bathroom or allowing a resident to lie in body waste; consumption of a resident's food; theft of money or personal belongings
More abusive behavior in health care settings: physically striking or any other assaultive behavior of or toward a resident; violation of a resident's right to make decisions; failure to provide privacy.
The older adults we care for are ill or infirm. As nurses, we tend to focus on their ____________, cares and treatments. We can easily lose our ___________ of the older pt as both a person and a member of the human race. physical needs; perspective
crimes against the elderly scams/white collar crimes
Crime is of particular concern to the elderly because of their: sense of vulnerability
Nurses can be instrumental in reducing fear of crime and assisting elders in exploring security-conscious behaviors that will: decrease vulnerability to victimization
The most dependent older adults _______________, which is typically provided in ___________. require more extensive assistance; nursing homes or extended care facilities
LTC facilities are licensed by the state and regulated by both: federal and state laws
Three levels of care provided by nursing homes: basic care facilties; sub-acute care facilities; skilled care facilities
Provide to level of care and supervision necessary to maintain the resident's safety and wellbeing; provide assistance with ADLs, including hygiene, ambulation, nutrition, elimination and other basic needs. Basic care facilities
Provide comprehensive inptient care designed for individuals who have an acute illness, injury, or exacerbation of a disease process. Sub-acute care facilities
Provide skilled nursing care on a regular basis; interventions such as administration of meds and skilled treatments that require the expertise of registered and vocational nurses; provides physical, speech, occupational and respiratory therapy Skilled care facility
___________ are desgnd to meet the special needs of people with ________ are gaining popularity. Specialty residences; Alzheimer's disease or other memory loss
Approx. $1.5 _______ is pend annually on health care in the US. Close to _____ is spendt on people over 65. trillion; 1/3
government program that provides health care funding for older adults and those with disabilities Medicare
covers inpatient hospital care, extended care in a skilled nursing facility following hospitalization, some home health care services and hospice services; pt is required to pay a deductible of $792 on hospital stays. Medicare Part A
covers 80% of customary and usual rates charged by physicians after deductibles are met; includes ambulance transport, PT, OT,and speech therapy, home health care, medical supplies and equipment and outpatient surgery and blood transfusions Medicare Part B (optional, but most people choose this)
system that Medicare instituted in the 1980's that says a hospital is paid a set amount based on the pt's admission diagnosis Diagnosis-Related Groups (DRGs)
The elderly will be the ____________ segment of the population and will have the greatest effect on the delivery of health care. fastest
Older adults of the 21st century are better educated; more involved in community and political activities; more knowledgeable consumers of health care
Safe _______ and efficient mass transportation to stores and recreaional facilities will _____________, as well as one-stop-shopping senio centers. housing; continue to be needed
Future plans for the elderly will need to include: lifelong learning opportunities that help them maintain wellness; preparing for retirement and leisure time; financial planning; advances in technology; ob training and retraining for "early retirees" who wish to remain employed.
Created by: akgalyean
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