Gerontology 3 of 3
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| Adjustment for the family of a dementia pt can be enhanced by integrating the care of the family into the: | nursing care plan
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| _____________ and ______________ add to the burden of families of dementia pts. | Financial problems; multiple role responsibilities
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| Families of dementia pts should be encouraged to consider: | adult daycare, or respite care if the elder resides at home
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| The most common form of dementia is: | Alzheimer's Disease (70%)
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| Alzheimer's disease is the _____ leading cause of death in the elderly population. | fourth
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| Alzheimer's is caused by a loss of neurons in the ___________ and __________ lobes of the brain, which control thinking and processing. | frontal and temporal
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| Alzheimer's pts are unable to __________ and __________ new information as well as retrieve memory. | process; integrate
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| Stage of Alzheimer's where there are mild short-term memory difficulties; difficulty learning new things; mild depression | early stage
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| 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
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| stage of Alzheimer's where pt shows severe memory impairment; impaired mobility; deteriorating speech; bedridden; weight loss; difficulty swallowing | late stage
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| Treatment of Alzheimer's is primarily: | symptomatic (symptoms are teated as they come up)
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| treatment for Alzheimer's that work by increasing acetylcholine in the cerebral cortex | cholinesterase inhibitor drugs
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| cholinesterase inhibitor drugs | tacrine (Cognex), donepezil (Aricept), galantamine (Reminyl), rivastigmine (Reminyl), rivastigmine (Exelon), Nameda
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| Other Alzheimer's drugs: | indomethacin (Indocin), estrogen, vitamin E, folic acid, possibly cholesterol-lowering drugs
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| Nursing interventions for Alzheimer's: | depend on stage of illness
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| behaviors associated with cognitive disorders: | agitation/hostility/paranoia; usually preceded by increasing irritability; may have sudden explosive outburst; may be talking louder or pacing
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| Unusual behavior may also occur as a _____________ response to confusion, fear, or sensory loss. | self-protective
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| 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
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| Safety for the cognitively impaired - mild impairment | patient may be able to stay in own home safely
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| 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
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| 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
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| 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
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| 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)
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| 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
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| 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
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| 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
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| 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
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| 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
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| Interventions for depression, alcoholism, and suicide: | tricyclics, antidepressents (MAOIs), selective serotonin reuptake inhibitors (SSRIs), electroconvulsive therapy, outpatient counseling or immediate crisis intervention
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| Any thougts or words of suicide must: | take a priority and be reported.
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| S/S of depression: | sleepy; low energy; staying home; decreased energy; lack of appetite
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| S/S of someone contemplating suicide: | giving away their belongings, calling people to say goodbye
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| Assessment of Depression in Elderly | pg. 855
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| 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
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| 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
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| Types of Abuse | pg. 856
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| defined as failure to provide for the self because of a lack of ability or lack of awareness | self neglect
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| 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
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| life threatening or suicidal acts can include: | wandering, isolation or substance abuse
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| 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
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| Stress for the caregiver builds, leaving them feeling: | trapped, frustrated, or angry
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| any action that causes physical pain or injury | physical abuse
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| Failure to provide food and fluids is considered: | physical abuse
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| Most common form of abuse; it accounts for alost half of the verified cases of elder abuse | neglect
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| passive form of abuse in which caregivers fail to provide for the needs of the older person under their care | neglect
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| 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
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| includes behaviors such as isolating, ignoring, or depersonalizig older adults; may be verbal or non-verbal | emotional abuse
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| Repeatedly ignoring what the older person has to say or avoiding social interaction with the individual are _________ forms of abuse. | subtle
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| 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
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| 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
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| Information related to the client must be kept: | confidential
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| All observations, both objective and subjective, must be carefully ____________. | documented (in case legal action is required)
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| Detailed _________ should be kept. | records
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| 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
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| 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
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| 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.
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| 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
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| crimes against the elderly | scams/white collar crimes
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| Crime is of particular concern to the elderly because of their: | sense of vulnerability
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| Nurses can be instrumental in reducing fear of crime and assisting elders in exploring security-conscious behaviors that will: | decrease vulnerability to victimization
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| The most dependent older adults _______________, which is typically provided in ___________. | require more extensive assistance; nursing homes or extended care facilities
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| LTC facilities are licensed by the state and regulated by both: | federal and state laws
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| Three levels of care provided by nursing homes: | basic care facilties; sub-acute care facilities; skilled care facilities
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| 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
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| Provide comprehensive inptient care designed for individuals who have an acute illness, injury, or exacerbation of a disease process. | Sub-acute care facilities
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| 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
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| ___________ are desgnd to meet the special needs of people with ________ are gaining popularity. | Specialty residences; Alzheimer's disease or other memory loss
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| Approx. $1.5 _______ is pend annually on health care in the US. Close to _____ is spendt on people over 65. | trillion; 1/3
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| government program that provides health care funding for older adults and those with disabilities | Medicare
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| 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
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| 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)
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| 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)
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| The elderly will be the ____________ segment of the population and will have the greatest effect on the delivery of health care. | fastest
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| Older adults of the 21st century are | better educated; more involved in community and political activities; more knowledgeable consumers of health care
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| Safe _______ and efficient mass transportation to stores and recreaional facilities will _____________, as well as one-stop-shopping senio centers. | housing; continue to be needed
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| 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.
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