Approach to NH client

Question 1

Crystallized intelligence

Answer 1

refers to knowledge and skills that are accumulated over a lifetime

Question 2

Fluid Intelligence

Answer 2

the ability to reason and thin abstractly. This type of intelligence decreases as you age

Question 3

What percent of the elderly population is in the nursing home?

Answer 3

5%

Question 4

old

Answer 4

65-75 years

Question 5

old old

Answer 5

76-85 years

Question 6

frail old

Answer 6

> 85 years old

Question 7

What percentage of the elderly population live in communities

Answer 7

95%

Question 8

What is the leading cause of death in elderly patients

Answer 8

heart related diseases

Question 9

What are the Error Theories in nursing (stochastic)

Answer 9

Wear and Tear Theory
Free Radical Theory
Cross - Link Theory

Question 10

What are the sociologic theories of aging

Answer 10

Disengagement Theory
Activity Theory
Continuity Theory

Question 11

Disengagement Theory

Answer 11

Withdrawal from one’s society and community is natural and acceptable

** very controversial because it implies that as we age we withdraw from society to allow younger people to take our roles

Question 12

Activity Theory

Answer 12

Individuals need to stay active if they are to age successfully.
Promotes satisfaction and positive self concept
Physical or Intellectual
** want them to remain as active as possible

Question 13

Continuity theory

Answer 13

With aging personality traits remain stable
As they age try to maintain previous habits, preferences, commitments & beliefs.
Iexplains that life satisfaction with engagement and disengagement depends on personality traits. 3 ideas about personality are important:
In the normal progression of aging personality traits remain stable
Personality influences role activity and one’s level of interest in particular roles
Personality influences life satisfaction regardless of role activity.
Basically-how they have been throughout their life they will remain. Keep previous habits

Question 14

What are the Psychosocial Theories

Answer 14

Jung’s Theories of Personality
Developmental Theories
Theory of Gerotranscendence

Question 15

Jung’s Theory of Personality

Answer 15

Jung a contemporary Freud, proposed a theory of development of personality through life. One moves from extroversion to introversion. One examines at midlife. Question their dreams, values and priorities. The development of the inner person and psyche are accomplished by search for personal meaning and the spiritual self

Question 16

Developmental Theories

Answer 16

Erik Erikson - Ego Integrity vs Despair.

Individuals can look back on their lives with joy, view the mistakes they have made and be content.. He later

Question 17

Theory of Gerotranscendence

Answer 17

associated with wisdom and spiritual growth. Similar to Erikson’s concept of integrity and Maslow’s self-actualization.
Value family.

Question 18

When choosing a nursing intervention remember to choose an intervention that is

Answer 18

consistent
professional
supportive
therapeutic

Question 19

What are the 5 Cs

Answer 19

competance
compassion
conscience
commitment
confidence

Question 20

When using Restorative Nursing you should work to

Answer 20

Maintain Bowel & Bladder Function
Promote Social Well-Being
Maintain Sensory Perception
Promote Psychosocial Health
Enhance Self-Esteem
Avoid Elder Talk
Avoid Ignorance

Question 21

When talking to a hearing impaired patient one should

Answer 21

Never Assume Hearing Loss is because of age
Face the individual, stand and sit at same level.
Gain the individuals attention
Speak distinctly
Pause between sentences and phrases
Remove background noise

Question 22

When communicating with a visually impaired patient one should

Answer 22

Use contrasting colors
Use low-vision assistive devices
Use orientation strategies 
Have the person’s Attention prior to talking
Speak promptly and clearly
Speak normally

Question 23

What are some hazards related to hospitalization?

Answer 23

Decline in Muscle strength
Vasomotor Instability
Reduced Bone Density
Diminished Pulmonary Ventilation
Sensory Deprivation
Tendency to Urinary Incontinence.

Question 24

How can you avoid hazards related to hospitalization

Answer 24

De-emphasize Bed rest
Remove High Hospital Bed with Rails
Actively Facilitate Ambulation
Socialization - talk with patient (they are the ones that need the extra time with you)
Interdisciplinary Care & Shared Objectives - talk with other nurses and physicians abut how to make the stay less hazardous

Question 25

What is delirium

Answer 25

any altered state/change in mental status that can be reversible

Question 26

What are some interventions to prevent delirium

Answer 26

``` Know baseline mental status Assess and underlying mental status - they may not normally be that way Assess sensory deficits Attention to basic needs Medication Review - are their medications causing this altered state; don't assume they are always like this Understand Behavior Maintain Safety Minimize Use of Invasive Equipment Environmental Modifications ```

Question 27

How do you assist Alzheimer's patients

Answer 27

``` Give one direction at a time Speak slowly: give simple directions Do not force Avoid Restraints Repeat yourself as often as necessary Give encouragement Praise accomplishments as activity progresses Be patient ```

Question 28

On a skin assessment of the elderly what should you see

Answer 28

Skin uneven in certain areas, increased creases, wrinkle lines and skin lesions Warm skin, but hand and feet may be cool Decreased skin turgor and dry and flaky skin Increased facial hair in women Coarse dry hair and flaky scalp (senile xerosis) Nails- yellow, dry, brittle, and longitudinal ridges

Question 29

HEENT for elderly

Answer 29

could see decrease ROM caused by musculoskeletal changes Lymph tissue decreases in size with aging and should not be palapabe Non palpable thyroid Typically have decreased near vision, but far vision might still be intact; decreased peripheral and dry eyes Increased difficulty hearing high pitched sounds Equilibrium and balance problems Ears still elongate/grow Decreased sense of smell Buccual mucosa and gums thin and pale Dry oral mucosa Decreased sense of taste, gag refelc, and papillae on tongue, varicose veins on tongue

Question 30

Enophthalmus

Answer 30

recess of eyeball into orbit

Question 31

Arcus senilis

Answer 31

White to yellow deposit at outer edge of cornea

Question 32

Fundoscopic Retina

Answer 32

retina and optic disc become smaller with age

Question 33

Respiratory for elderly

Answer 33

Senile kyphosis (barrel chest/increased A+P diameter) Decreased respiratory excursion Cheyne-Stokes breathing may occur during sleep decreased breath sounds with few crackles at bases

Question 34

CV for elderly

Answer 34

Increase in premature beats and irregular pulse Stiffer arteries slight increase in BP and wider pulse pressure Orthostatic drops in BP

Question 35

GI for elderly

Answer 35

Soft abdomen (decreased musculature) Decreased bowel sounds Look for old scars - could help provide info about surgeries Prostate soft and smooth; not enlarged

Question 36

Female Reproductive for elderly

Answer 36

saggy, cordlike breasts decrease and greying of pubic hair skin in peritoneal think elastic and shiny pale vaginal walls and glistening cervix d/t reduced estrogen ovaries should not be palpable

Question 37

Male reproductive for elderly

Answer 37

``` Gynocomastia decrease and greying of pubic hair decrease in size of scrotum and penis low hanging testes and few rugae prostate enlargement ```

Question 38

Musculoskeletal in elderly

Answer 38

decreased arm swing in gait wider base of support decline in step length, decrease spinal rotations slowing of motor responses increased unsteadiness decreased ROM = crepitation/stiffness in ROM decreased muscle strength and tone; hand grip usually remains intact

Question 39

Neurological in elderly

Answer 39

Use MMSE and Clock Scoring test to screen for dementia Memory Loss does increase with age CN nerves olfactory and optic = decreased (fundoscopic probs) III oculomotor - pupils smaller V - trigeminal -increased stimulation needed to elicit corneal reflex VII-facial IX-glossopharyngeal - decreased taste Reflexs - Rombergs sign (swaying) normal decreased deep tendon reflexes