midterm Flashcards
(294 cards)
1
Q
primary aging
A
physiological aging related to time (senescence)
2
Q
secondary aging
A
changes related to trauma or disease process
3
Q
primary, secondary, tertiary prevention
A
P = vaccines, education
S = pap test
T = meds to keep chronic conditions controlled
4
Q
biological theories
A
programmed
damage/error
5
Q
programmed aging theories are
A
- senescence
- gene
- endocrine
- immunologic
- nutritional
6
Q
senescence aging
A
cells natural loss of function over time
7
Q
gene aging
A
: life span is inherited
8
Q
endocrine aging
A
aging is controlled by hypothalamus
9
Q
immunologic aging
A
Decrease of T cells leads to infections
10
Q
nutritional aging
A
diet affects aging
11
Q
damage/error aging theories
A
- wear & tear
- cross-linking
- free radicals
- somatic mutation
- environment
12
Q
wear & tear aging
A
body parts wear out
13
Q
cross-linking aging
A
DNA / proteins cross link with sugars and become stiff
14
Q
free radicals aging
A
toxins damage cells; anti-oxidants neutralize toxins
15
Q
somatic mutation aging
A
DNA damage (telomeres)
16
Q
environmental aging
A
environmental toxins damage cells
17
Q
psychosocial theories of aging
A
- role
- person-environment fit
- activity
- continuity
- disengagement
- age stratification
- gero-transcendence
18
Q
role aging
A
adaptation to different roles at late life is required
19
Q
person-environmental fit aging
A
changes in competencies and needs due to aging influence ability to deal with environment
20
Q
activity aging
A
active / productive life leads to life satisfaction and better health outcomes
21
Q
continuity aging
A
continuation of life roles and habits slows aging
22
Q
disengagement aging
A
there is a natural separation of old people from society (theory not supported currently)
23
Q
age stratification aging
A
cohorts that age together share experiences
24
Q
gero-transcendence aging
A
spirituality has a greater role in life and in acceptance of death
25
developmental aging theories
- maslow
- jung
- erickson
- peck
- havighurts
26
maslow's aging
self-actualization as a goal of aging but lower hierarchy needs must be met
27
jung aging
self-realisation, search for true self and spirituality
28
erickson aging
ego-integrity vs. despair (life satisfaction vs. unmet goals and regrets)
29
peck aging
new identity and new meanings beyond self-centeredness
30
havighurst aging
adjustment and adaptation tasks for late life changes
31
nursing theories for aging
- functional consequences
- theory of thriving
- successful aging
- compensation/selective optimization
32
functional consequences aging
aging causes functional decline
33
Theory of Thriving aging
harmony between environment and relationships
34
Successful Aging:
successful aging as a process of adaptation
35
Compensation / Selective Optimization aging
strategies to manage and cope with aging are required
36
presbyopia
Lens becomes less elastic which decreases the focusing power and causes decreased visual acuity
37
Presbycusis
most common form of hearing loss associated with aging
38
xerostomia
Reduced saliva production (dry mouth)
39
sarcopenia
Decrease in muscle mass, strength and endurance
40
possible causes of atypical illness presentation in older adults:
1. Age-related physiologic changes
2. Age-related loss of physiologic reserve
3. Interactions of chronic conditions with acute illnesses
4. Underreporting of symptoms
41
4 “I’s” Warning Red Flags:
Instability, Incontinence, Immobility, Intellectual impairment
42
pneumonia older adult presentation
Absence of the usual symptoms (cough, SOB, sputum), malaise, anorexia,
confusion, insidious onset
43
MI older adult presentation
Mild or no chest pain, confusion, weakness, dizziness,
SOB
44
UTI older adult presentation
Absence of dysuria, confusion, incontinence, anorexia
45
acute appendicitis older adult presentation
Diffuse abdominal pain, confusion, urinary urgency,
absence of fever or tachycardia
46
infection older adult presentation
Temperature normal or below normal, absence of
tachycardia, slightly elevated or normal white blood cell
count, decreased intake, confusion
47
depression older adult presentation
Confusion, apathy, absence of subjective feeling of
depression, somatic complaints (GI, constipation,
insomnia)
48
hypoglycemia older adult presentation
Light-headedness, confusion, vertigo, falls
49
hyperthyroidism older adult presentation
Depression, lethargy, anorexia, constipation, cardiac
symptoms
50
hypothyroidism older adult presentation
Confusion, agitation
51
acute abdomen older adult presentation
Mild discomfort, constipation, some tachypnea
52
nonspecific symptoms that may represent specific illness
confusion, self-neglect, falling, incontinence, apathy,
anorexia, dyspnea, fatigue
53
goals for care for older adults
- maintain self care
- prevent complications of aging or existing conditions
- delay decline
- achieve highest possible quality of life
54
responsive behaviours of dementia
indicate unmet needs
55
protective behaviours in dementia
indicate the person's attempt to protect themselves
56
person-centered care approach
- treating w/ dignity & respect
- understanding hx, culture, etc
- looking at situations from person POV
- providing opportunities for person to have convo w/ others
- ensuring person has chance to try new things/participate in activities
57
gentle care philosophy
arrange environmental b/w person w/ dementia & physical space, programs, & other pt
58
Gentle Persuasive Approaches - teaching dementia care
- body containment strategies (learning about brain changes = responsive behaviours)
- personhood (knowing & focusing on person behaviour)
- unmet needs & behaviour (learning how to interpret aggressive behaviour as response to unmet needs)
59
Gentle Persuasive Approaches - Body containment strategies
- de-escalation, respect, person-centered, safety
- avoid restraints
- manipulate environment!
- stop & go
60
what is stop & go
when the person is resistive to care – stop, pause and re-approach
61
Gentle Persuasive Approaches (GPA) Care Tips
- Learn what makes the person happy and provide it
- Concentrate on the person, not the task
- Sometimes doing nothing is the best thing
- Have one calm person interacting with the client
- Allow personal space
- Remember that many behaviours are time limited
- Identify triggers and unmet needs
62
Neurogenic Reflex Grab
- Person with dementia will often instinctively grab on when something comes in close contact
- Interpreted by staff as aggressive behavior
- pulling away reinforces the reflex and the person will simply tighten their hold
63
eden alternative
It utilizes children, plants and animals to fight loneliness, helplessness and boredom experienced by the elderly living in care facilities
64
The GRACE (The Geriatric Resources & Care of Elders) Model
support team (NP & SW) & multidisciplinary team & staged process to develop & implement an individualized plan for each pt
- The support team then meets with the patient’s primary care provider to finalize the patient’s care plan.
- The final step involves the support team working with the patient and his or her family or caregiver to implement the plan.
65
Guided Care Model – Chronic Care Model
- involves: nurses & dr work together w/ pt w/ chronic conditions
- nurses: in-home assessments, care planning, teach strategies.. etc
66
ACE Model of Care Principles
- Care is patient-centered
- Treatment team is interdisciplinary
- Planning for discharge is part of care
- Hospital environment is elder friendly
67
The Older Adults Hospitalization Reduction Strategies
- Engage key stakeholders: patient, caregivers, hospital and skilled nursing staff, primary care providers, rehabilitation specialists, and home health workers.
- Assess risk and develop a comprehensive transition plan throughout the hospitalization.
- Enhance the safe management of medications.
- Place an emphasis on daily communication among the multidisciplinary team focused on a coordinated transition.
68
Ten Principles of Validation
1. ppl unique & treated as individuals
2. ppl valuable, no matter how disoriented
3. reason behind behaviour
4. behaviour d/t brain changes, physical, social, & psychological changes
5. can be changed only if person wants to change them
6. accepted non-judgementally
7. life stage has tasks, unable to complete = psych problems
8. memory changes = restore balance by retrieving memories from past
9. painful feelings that expressed, acknowledged & validation = diminsh
10. empathy!!!
69
P.I.E.C.E.S. Model
Physical (pain/conditions = change behaviour)
intellectual (affects memory, language, self-awareness)
emotional (problems adjusting to changes)
capabilities (knowing can/can't do)
environment (supportive to help support abilities)
social & cultural (unique social & cultural needs)
70
Teepa Snow’s Positive Approach
evolved to meet the complex and unique needs of individuals using effective and structured technique.
71
delirium
acute, fluctuating syndrome of altered attention, awareness, and cognition
72
diagnostic criteria for delirium
disturbance in attention (reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
tends to fluctuate
73
subtypes delirium
hypoactive
hyperactive
mixed
74
hypoactive delirium
- most prevalent
- "quiet delirium"
- lethargic, drowsy, quiet, withdrawn
75
hyperactive delirium
- agitated, combative
- disoriented
- psychotic features (hallucinations, delusions, illusions)
76
mixed delirium
mixed symptoms of hypo/hyper
77
delirium vs psych disorder
- psychiatric disorder almost always lacks the disorientation, memory loss, and cognitive impairment found in delirious patients.
- A history of manic illness or psychotic disorder suggests a diagnosis of psychiatric disease.
78
Delirium is misdiagnosed as depression in up to 40% of cases. (T/F)
TRUE
79
delirium risk factors
- age
- pre-existing cognitive dysfunction
- taking multiple medications
- infection
- chronic illness/comorbidities
- post op
- sleep deprivation
- so many other things..
80
are males or females at greater risk for delirium
MALES
81
PRISM-E underlying causes delirium
- pain
- restraint/retention
- infection
- sensory impairment/sleeplessness
- medication/metabolic disturbance
- emotions/environment
82
other causes of delirium
- drug toxicity
- substance abuse
- dehydration
- acute illness
- exacerbation of chronic disease
- elimination problems
83
suspect delirium when..
SUDDEN onset of altered behaviour
decreased ability to focus & pay attention
perceptual disturbances & impaired cognition
84
delirium is medical emergency - priorities
- focus & safety
- least restrictive measures
- remove all tubes & drains ASAP
- utilize haldol for agitation (produces sedation w/o amnesia)
85
test for delirium - 4AT
- months of year backwards
- asking pt day of the week
86
delirium vs dementia onset
del = rapid, decrease MMSE
dem = slow, decline of 2-3 MMSE points over years
87
delirium vs dementia symptoms
del = fluctuate over course of day
dem = relatively stable
88
delirium vs dementia duration
del = days to week
dem = years
89
delirium vs dementia orientation
del = disorientation & disturbed thinking internmittent
dem = persistent disorientation
90
delirium vs dementia LOC
del = fluctuates, w/ inability to concentrate
dem = alert, stable
91
delirium vs dementia sleep/wake cycle
del = sleep/wake cycle may be reversed
dem = sleep fragmented
92
CAM
1. evidence of acute change in MS
2. inattention, difficulty focusing attention
& either/or
3. disorganized thinking
4. altered LOC
93
delirium? assess
VS, BW, hydration, CBG, MSE, urine..
94
delirium treatment goals
- nonpharm measures
- establish routine & comfortable surroundings
- reassurance
- reduce sensory stim
- rest & sleep
95
delirium prevention triad interventions
1. prevent sleep deprivation
2. monitor hydration / prevent dehydration
3. prevent stimuli deprivation / ensure vision & hearing
96
nonpharm interventions for delirium
- hydration
- early mobilization
- removal catheters
- repeated reorientation
- glasses/hearing aids
- promote good sleep
97
nice & easy approach when working with delirium
- name
- introduce self
- contact (firm pressure)
- eye contact
- explain (what ur doing BEFORE)
- avoid arguments
- smile (calm & reassuring)
- you are in control (change approach if necessary)
98
dementia
global loss of all higher intellectual function, memory and cognitive function, accompanied by disintegration of personality and behaviour
99
is dementia a normal part of aging
NO
100
key features of dementia
- Most types of dementia are non-reversible, chronic and progressive.
- Symptoms occur slowly over months to years.
- Cognition, mood, functional ability and behavior are affected.
101
dementia risk factors
- age
- genes
102
dementia symptoms
- essential development of multiple cognitive deficits:
- concentration
- coordination
- initiation
- self-monitoring & self-correction
- emotion regulation
- inhibition
103
Behavioral and mood changes result in “Responsive behaviours”:
aggression, agitation, anxiety, sexual disinhibition, wandering
104
7A's of dementia
- anosognosia
- amnesia
- apathy
- agnosia
- apraxia
- aphasia
- altered perception & attention deficit
105
anosognosia is
lack of insight
- unaware of changes
- doesn't recognize effects of disease
106
amnesia
memory loss
- last thing learned is first thing lost
107
apathy
loss of initiation
- lost ability to begin activity on own
- will engage in convo or activity if someone else begins
108
apathy vs depression
- depressed will participate if engaged by someone else
- apathy is not choosing but rather person has lost the ability to initiate activities
109
agnosia
loss of recognition
- trouble understanding meaning of what seen, heard, smell, touched
- loss recognition of ppl that last came into their life (ex: grandchildren)
110
apraxia
loss of purposeful movement
- lose ability to plan, sequence and carry out steps of particular tasks
- trouble understanding directions
111
aphasia
loss of language skills
112
attention deficit
difficulty maintaining attention & easily distracted
113
categories of dementia
early: familial alzheimers, frontotemporal dementia
rapidly progressive dementia: creutzfeldt-jakob disease
later onset dementia: 4 primary types
114
primary types of dementia
- alzheimers
- vascular dementia
- dementia with lewy bodies
- frontotemporal dementia
115
alzheimers
most common, memory loss, mood/behaviour changes, damage & death of brain cells
116
vascular
interrupted blood supply to brain (post stroke), step progression
117
FTD
middle age, personality changes, impaired executive functions, mental rigidity, perseveration
118
lewy dementia
protein deposits in nerve cells, fluctuating alertness, repeated falls, tremor, hallucinations, delusions
119
alzheimers cause what kind of changes in brain
formation of plaques, tangles, brain shrink, inflammation
120
vascular dementia is described as
problems in circulation of blood in brain
generally irreversible
impairment experienced related to area of brain that damaged
121
Responding to BPSD: ABC Method
Antecedent (trigger)
Behavior
Consequence
Serves to better understand triggers and pattern of behaviors so appropriate measures can be implemented
122
When can medication use be considered for dementia
Behaviour is dangerous, distressing, disturbing, damaging to social relationships and persistent
AND
Has not responded to consistent nonpharmacological treatment plan
OR
Requires emergency, short-term treatment to allow proper investigation of underlying problems
123
Citalopram and Sertraline used for
irritability
124
Risperidone used for
short-term therapy of aggression and psychosis
125
quetiapine & haldol used for
aggressive behaviours
126
trazadone used for
sleep aid or mild tranq
127
Pharmacotherapies for BPSD
- Irritability: citalopram and sertraline
- Aggression: haldol, quetiapine, risperidone
- Psychosis: risperidone, olanzapine, quetiapine
- Depression : citalopram, sertraline, mirtazapine, trazadone
- Sleep problems: trazadone, zopiclone
- Impulsivity: carbamazepine, gabapentin
- Hyper-sexuality: Cyproterone (Androcur)
128
What antipsychotic medications are not effective for?
- Aimless wandering
- Inappropriate urination/defecation
- Inappropriate dressing/undressing
- Vocally repetitious behaviour (calling out)
- Hiding/hoarding
- Eating inedibles
- Tugging/removing restraints
- Pushing wheelchair bound co-resident
129
sun-downing
increase behavioural problems that begin at dusk --> night
130
precipitating factors of sundowning
- End-of-day exhaustion (both mental and physical)
- An upset in the "internal body clock," causing a biological mix-up between day and night
- Reduced lighting and increased shadows causing people with Alzheimer's to misinterpret what they see, and become confused and afraid
- Disorientation due to the inability to separate dreams from reality when sleeping
- Not as much or no activity in the afternoon compared to the morning can lead to restlessness later in the day
131
Person – Centered Communication
- Focus on connecting rather than correcting
- Guide rather than tell or control
- Distract rather than confront
- Avoid ‘no’ or ‘don’t’
- Use short sentences
- Use non-verbal expressions such as smiling, nodding, gesturing, pointing
132
Pharmacological Treatment of Alzheimer’s Dementia
Cholinesterase Inhibitors (ChEI)
not effective treat agitation
133
ChEIs Side Effects:
Nausea
Diarrhea
Muscle cramps
Insomnia / vivid dreams
134
nursing consideration of ChEls
pulse, breathing, stomach discomfort, seizure risk
135
Aricept (donepezil) increases the risk of two rare but potentially serious conditions:
muscle breakdown (rhabdomyolysis)
neuroleptic malignant syndrome (NMS)
136
later life depression
older adults with depression will present for treatment of physical conditions, rather than for evaluation for a mood disorder. But it’s essential to assess the patient’s mood regardless of presenting symptomatology, because mood independently affects daily functioning and can impede treatment for medical comorbidities
137
Depression in the Elderly
- Patients often do not recognize their depression
- Early morning awakening
- Somatic presentations
- Anorexia, weight loss
- Onset or recurrence of substance abuse
- Exaggeration of pre-morbid personality traits
138
SIGECAPS
- sleep disorders
- interest decreased
- guilt
- energy decreased
- concentration difficulties
- appetite disturbances
- psychomotor retardation/agitation
- suicidality
139
The suicide rate for older adults is two to three times higher than for the general population. (t/f)
TRUE
140
is path warm
I Ideation
S Substance Use
P Purposelessness
A Anxiety / Agitation
T Trapped
H Hopelessness / Helplessness
W Withdrawal
A Anger
R Recklessness
M Mood changes
141
medication use concerns in older adults
- changes related to aging: affect OA differently
- compliance: overuse, underuse
- polypharm
- adverse drug reactions
- drug interactions
142
are OA biggest users of prescription & OTC
YES
143
the more drugs one is taking the greater the chance of
drug/drug interactions & adverse reactions
144
dementia mnemonic for drugs
D = drugs
E = eyes & ears
M = metabolic (endocrine, electrolytes)
E = emotional (depression, grief)
N = neurological (parkinson's, alzheimers)
T = trauma/tumor
I = infections
A = arteriosclerosis
145
pharmacokinetics
movement & action of drug in body
146
4 major pharmacokinetic processes
absorption, distribution, metabolism, excretion
147
absorption age related changes
- decreased surface area & blood flow to GI
- decreased GI motility
- increased pH
- reduced salvia production
- reduced volume of pancreatic secretions
148
distribution changes
- decreased albumin (risk digoxin, warfarin, diazepam)
- increased lipoprotein (propranolol, lidocaine)
- less body water
- higher fat content
- decreased muscle
149
metabolism changes
- reduced hepatic blood flow (CCB, BB, narcotics)
- decline in oxidative metabolism (lorazepam etc "pams")
150
polypharm
use of multiple medications
151
brown bag test
bring in all prescribed meds, OTC meds, herbal meds to appointment
152
prescribing cascade
meds are prescribed to treat effects of other medications
153
polypharm prevention "SAIL"
S = simplify
A = adverse effects
I = indication
L = list
154
polypharm prevention "TIDE"
T = time
I = individualized
M = drug interactions
E = educate
155
adverse drug reactions
unintended, unwanted, harmful effect of drug that occurs at normal drug dose
156
adverse drug reactions 7X more common in OA
yes
157
adverse reaction causes
- improper drug/dose selection
- nonadherence
altered pharmacokinetics
multiple meds
multiple prescribers
158
adverse reaction risk factors
- over 85
- live alone
- lower body weight
- HX drug reaction
- alcohol
- recent hospital
- dementia
- polypharm
- multiple chronic disease
159
adverse reaction consquence
- falls
- GI distress
- incontinence
- constipation
- depression
- anxiety
- confusion
160
acute dystonia
abnormal involuntary movements / slow muscle contractions
TX; benztropine, benadryl, ativan
161
akathisia
restlessness
162
NMS
- extreme rigidity
- fever
- dizziness/fainting
- fluctuating LOC w/ high creatinine kinase & leukocytosis
163
meds commonly used in OA
- benzo
- neuroleptics
- NSAIDs
- tylenol
- laxatives
- antidepressants
- phenytoin
- warfarin
164
meds associated with delirium
- neuropsych meds
- allergy meds
- sedatives
- GI meds
- cardio meds
- analgesics
- corticosteroids
165
inappropriate meds: beers criteria intentions
- improve medication selection
- educate clinicians
- reduce adverse drug events
- serve as tool for evaluating quality of care, cost, and patterns of drugs
166
medication adherence challenges
- lack of understanding
- barriers to communication
- sensory impairment: poor vision
- cog impairment: forgetting
- complex regimen
- inconvenient packaging
- adverse events
- cost
- social isolation
167
med use & adherece nursing role
- advocate & serve as pt defense against med error
- advocate for meds to be taken with the least frequency possible
- assess for S/E
- education
- simple language
- ensure pt has glasses, hearing aids before education
- teach regarding to negative effects
168
nursing cate for chronic illness
preservation of function and prevention of further deterioration of health status
169
chronic illness trajectory traditional model
- pre traj = no sx; preventive phase
- traj onset = sx present
- crisis = life threatening
- acute = active illness and complications
- stable = sx controlled
- unstable = sx diff control
- downward = progressive deterioration; increase sx
- dying
170
shifting perspective model
- living w/ chronic illness as ongoing shifting b/w wellness and illness
- reflects pt-centered
- goals: minimize risks, alleviate sx, avoid complications, max function, preserve hope
171
nonfatal vs serious potentially fatal ilness
N = arthritis, vision impairment
S = cancer, stroke
172
fraility
state r/t aging process in which multiple body systems gradually lose their built-in reserves
greater risk for catastrophic outcomes (falls --> death)
173
OA defined as frail d/t functional decline more likely to present with ANY
geriatric syndrome
174
geriatric syndrome progression
old age, functional & cognitive decline, impaired mobility ---> incontinence, falls, PU ---> frailty ---> failure to thrive
175
ex of geriatric syndrome
falls, depression, delirium, demetia, incontinence
176
SPICES geriatric syndrome screening tool
S = sleep disturbances
P = problems w/ eating
I = incontinence
C = confusion
E = evidence of falls
S = skin breakdown
177
identifying failty
- prisma 7
questions & 3 or more yes indicate increased risk of frailty
178
gait speed test
average gait speed of longer than 5 sec to walk 4 meters = frailty
179
prevention and management of frailty
- early identification
- proper tx of acute & chronic
- promotion of activity
- promotion of proper diet
- falls prevention
- avoidance of polypharm & alcohol & smoking
- advance care planning
180
failure to thrive
- state of progressive functional decline, progressive apathy, loss of willingness to eat/drink
- culminates in death
- SHOULD NOT be considered normal aging
181
4 domains critical to development of FTT
- impaired physical function
- malnutrition
- depression
- cognitive impairment
182
FTT etiology - 11 D
- diseases
- dementia
- delirium
- drinking alcohol
- drugs
- dysphagia
- deafness
- depression
- desertion by family
- destitution
- despair
183
FTT signature consequences
- weight loss
- dehydration
- low cholesterol & albumin
- increased infections
- fractures
- pressure ulcers
- increased mortality
184
vulnerability risk red flags
- repeat ER visits
- neglect
- lack of followup appt
- noncompliance
- acute deterioration in ADL
- unexplained weight loss
- poor grooming
- refusal of needed assistance
- threat of eviction
185
vulnerability & ethics
- actual risk vs potential risk
- tolerable vs intolerable risk
- decisional capacity vs incapacity
- autonomy vs duty to intervene
186
nursing prevention strategies for FTT
- mobilization
- exercise & balance training
- mental activity
- nutrition
- social supports
- ASSESSMENTS
187
parkinsons
progressive neurodegenerative disease of basal ganglia & involves dopamine pathway
abnormal movements
188
severity of PD depends on
degree of neuron loss & reduction of dopamine receptors
189
PD men or women more effected
MEN hehe
190
risk factors PD
- advance age
- declining estrogen levels
- decreased vit B12 & folates
- exposure to heavy metals
191
types of PD
- primary or idiopathic (cause unknown)
- secondary to other medical condition
192
cardinal sx PD
- rest tremor
- rigidity
- postural instability
- bradykinesia
193
tremors
- 1st sx
- affects jaw, facial muscles, tongue, limbs
- disappears with movement
- pill rolling
194
rigidity
increased tone
195
bradykinesia
- slow movement
- reduced range
- difficulty with repetitve movements
196
postural instability
difficulty w/ balance
197
additional sx PD
- mask like facial
- muffled speech
- depression
- sleep disorder
- pain
- fatigue
- dementia
- writing changes
- loss of automatic movements
198
tx for PD
- levodopa w/ carbidopa = 1st line tx
199
levodopa
most effective
crosses blood-brain barrier & converted to dopamine
200
dopamine agonists
bromocriptine, pergolide, lisuride, ropinirole, pramipexole reduce trempr
201
osteoporosis
compromised bone strength predisposing to increased risk of fracture
202
early diagnosis technique for osteoporosis
dexa
203
dexa
best tech for assessing bone mineral density
T-score given = comparison of ur bone density to healthy 30 y/o
204
t-score below -2.5 SDs indicates
osteoporosis
205
frax
determines fracture probability
206
factors that increase risk of osteoporosis
- family hx
- osteopenia
- low body weight
- diet low in calcium
- low levels of physical activity
- ovaries removed
- past menopause
- vit D deficiency
- smoking
- excessive caffeine intake
- race
- excessive alcohol
207
conditions causing bone loss or fractures
- rheumatoid arthritis
- celiac disease
- gastric bypass surgery
- COPD
- chronic liver failure
208
tx for osteoporosis
- prevent fractures
- healthy lifestyle choice
- balanced diet
- adequate calcium & vit D
- fall prevention
- weight bearing exercises
- resistance exercises
- flexibility exercises
209
vertebral compression fractures most common complication of osteoporosis
TRUE
210
gout
inflammatory arthritis that occurs as result of increased uric acid levels in blood which leads to accumulation of urate crystals in joints, soft tissues, kidneys
211
uric acid is
waste product, secreted when body breaks down purines
212
diagnosis of gout
aspirate fluid from swollen joint
213
acute gout
painful, affects one joint
214
chronic gout
repeated episodes of pain & inflammation may involve more than 1 joint
215
risk factors gout
- hyperuricemia (greater 6.8)
- hypertension
- diabetes
- hyperlipidemia
- chronic kidney disease
- cardiovascular disease
- metabolic syndrome
216
tx for gout
- rest joint
- NSAIDs (indomethacin or naproxen)
- glucocorticoids
217
herpes zoster
reactivation of varicella zoster virus
remains dormant in dorsal root ganglion
218
sx prior to rash (shingles)
fever, general weakness, pain, burning, tingling sensation over area of body/face
219
rash
occurs in dermatome supplied by nerve
dermatome area of skin that mainly supplied by single spinal nerve
220
blisters dry & crust within 7-10 days
true
221
shingles pt teaching
- wash hands before/after touching
- take meds
- wear gloves when applying cream
- wear cotton
- refrain from touching people
222
antiviral meds
- start within 72 hrs of rash appearing
- do not kill virus but stop it from multiplying which is thought to limit severity of sx
223
transmission shingles
only possible to those not immune to chickpox & contact with fluid from blisters may cause chickenpox
placed in isolation
224
complication of shingles
postherpetic neuralgia = painful condition lasts more than 90 days after rash
225
prevention of shingles
- vaccine
226
arthritis
joint inflammation
227
rheumatoid arthritis
autoimmune condition that causes chronic inflammation
experience painful swelling of joints & become severely deformed
228
does rheumatoid arthritis affect joints symmertrically
yesd
229
risk factors of osteoarthritis
increased age, obesity, family hx, repetitve use of joint
230
osteoarthritis
cartilage breaks down & wears away
bone on bone = pain
231
is early intervention critical with osteoarthritis
YES
232
with osteoarthritis when is it worse
morning d/t long period of inactivity
232
pain and osteoarthritis
- initially present when joint used
- as disease progresses, pain present at rest, more joints become involved
- joints become enlarged, unstable, deteriorate crepitus
- range of motion reduced
233
intervention for osteoarthritis
- obtain tx ASAP
- control pain
- minimize disability
- provide teaching
- exercise
- physio for OA & RA to retain joint use
- weight loss if indicated
233
information control
withholding info
233
tx for osteoarthritis
- hot/cold therapy
- cold = acute process
- complementary & alternative meds
- music
- acupuncture
234
limiting options
not offering certain options
235
impeding pts ability to act upon their wishes
refusal to assist, compulsory tx, imposing restrictions
236
healthcare justifications
paternalism is acceptable because it serves to restore person autonomy
237
justification for limiting autonomy
- lack of capacity / competency
- potential to harm, self
238
risk assessment rules
- risk management interventions are never based on convenience or gratification
- negotiating risk ethically involves the minimal use of power to attain max benefit & min infrigement on pt liberty
- more grave consequences - the greater obligation to intervene
239
encumbered pt
whose judgement & decision making ability are hindered by distorting factors (brain damage), impairing emotional state (pain, grief), undue influence (manipulation) and inadequate / partial info
240
unemcumbered pt
competent & not subjected to distorting factors
241
advance directive
proxy (identified person to make decision) or instructional (what tx they want under what circumstance)
242
what act governs sub decision makers discretion & obligation
representation agreement act
243
best interest judgement
- what would reasonable person in pts position would want?
- considerations: current wishes, if condition likely to improve by care, whether benefit greater than risk, less restrictive care would be as beneficial
244
moral distress
when we know what right/ethical action but can't act on it
245
consequence of moral distress
- disempowering tension
- internal conflict
- self doubt
- chronic stress
246
ways to negotiate moral distress
- recognize, acknowledge, discuss openly, affirm feelings, accept our limitations
247
valid consent
- voluntarily given by pt
- fully informed
- chance to ask qts & receive answers
248
adult consent not required
- emergency
- invol psych
- triage
- communicable disease (TB)
249
2 types of decision makers
formal = duly appointed person
temp = chosen by healthcare provider
250
personal guardian
incapable adult not make representation agreement or advance directive while capable & healthcare & personal decisions need to be made
251
power of attorney vs representation agreement
PA = money & property
RA = health care & other personal matters
252
advance care planning
process that involves conversations, decisions, and identifying how poeple would like to be cared for
253
qualify as TSDM
- at least 19
- contact w/ adult preceding 12 mon
- no dispute w/ adult
- be capable of giving, refusing or revoking sub consent
- be willing to comply with duties
254
green sleeve
important doc on fridge
255
safeguards to maid
- written request before 2 independent witnesses
- 2 independent HCP
- 10 clear days b/w request & provision of maid
- msut be given opp to withdraw immediately before provision of maid
256
end of life care
care provided to person in their last weeks to days of life
257
end of life sub consent
- personal guardian (court)
- representative (individual)
- advance directive
- temp sub decision marker
258
SPEAK EOL decisions
s = sub decision maker
p = preferred tx option
e = expressed wishes
a = advance directives
k = knowledge of benefits & tx prognosis
259
MOST
m3 = full medical tx
m2 = transfer only when comfort measures can't be achieved
m1 = comfort measures only
c2 = intubation
c1 = no intubation
260
goals of palliative care
prevent & relieve suffering, enhance quality of life, optimize function, assist within decision making, provide opportunities for personal growth
261
spirituality and dying
important resource for addressing distress when facing death
262
assessing spiritual needs
asking about meaning in life, personal strengths & connectedness with higher self & explore how these values can influence decisions regarding health care choices and self care
263
spiritual needs in dying process
- need for relief from loneliness & isolation
- need to feel useful
- need to express anger
- need for comfort in anxiety and fear
- need to allevaite depression and find meaning in experience
264
spiritual work of dying process
- remembering r/t to reminiscence or a life review through which one can recognize the goodness of life
- reassessing is act of redefining personal worth
- reconciling means healing damaged or broken relationships
- reuniting refers to combining the material and spiritual elements of person & world
265
pron of death
- no apical for 1 min
- no spontaneous resp for 1 min
- pupils dilated & fixed
266
death charting elements
- events leading to death
- time resp ceased
- criteria to pronounce death
- death at ___
- time physician notified
- time family notified
267
good death
- pain/sx management
- avoiding prolonged dying process
- clear communication about decisions
- adequate prep for death
- feeling sense of control
- finding spiritual or emotional sense of completion
- affirming pt as unique and worthy
- not being alone
268
approaching death sx
- decreased LOC
- muscle relaxation/inability yo swallow
- restlessness
- congestion
- breathing laboured
- moaning likfe sounds
- incontienence
269
palliative discomfort
- pain
- delirium
- anxiety/depression
- dyspnea
- N & V
- dehydration
- diarrhea
- incontinence
- inability to perform ADLs
270
nursing interventions for dying
- ongoing assessment
- pain control
- reduce air hunger
- skin & mucous membrane care
- choices
- TR
- grooming
- spirituality needs
- communication
271
BATHE communication
B = background info
A = affect
T = trouble
H = handling things
E = empathy
272
mourning vs grief
G = individual response to loss
M = active & evolving process
273
acute grief
CRISIS!
somatic & psychological sx of distress that occur in waves lasting varying periods of time
274
anticipatory grief
response to a real or perceived loss before it occurs
275
ambiguous loss
type of loss that happens when a person with dementia is physically present, but at time psych absent
276
disenfranchised grief
person whose loss can't be openly acknowledged or publicly mourned experiences
277
chronic / dysfunctional grief
pathologic chronic grief begins with normal grief but obstacles interfere with normal evolution towards adjustment, towards the reestablishment of equilibrium
278
risk for dysfunctional grief
- dependency
- unexpected loss
- inadequate coping
- lack of support
- mental illness
- substance use
279
5 R's of spirituality
reason & reflection on meaning of life
religion
ritual practices
relationships
restoration = positive impact & influence spirituality
280
spiritual care interventions
- being with
- doing for
- looking inward
- looking outward
281
being with
- listening
- offering self/being present
- conveying acceptance, recognition
- meeting persons at their level
- creating trust
282
doing for
- holding hands/ tender touch
- exploring concerns
- making connections with other supports
283
looking inward
acknowledging spiritual dimension
- assessing spiritual needs
- developing a deeper understanding of cultural/religious views
- facilitating expression of thoughts r/t existential issues
- helping to make sense and derive meaning from experiences
- encouraging grieving over losses
284
looking outward
- referring to pastoral care
- encouraging & affirming value of being part of religioud community
- teaching lifestyle alteration focused on self care
- encouraging prayer
- helping find joyful & pleasurable activities
285
spirituality and dementia
memory may be lost, needs continue and remain strong
286
types of elder abuse
- physical
- sexual
- emotional
- medical
- financial
- neglect
- abandonment
287
what is most common type of abuse
financial
288
risk factors of elder abuse
advance age (80)
women
disability
dementia
depression
social isolation
289
types of abuse by nurses
- embarrassing or offensive comments
- yelling/swearing
- deliberate ignore care needs
- roughness
- hitting
- sexual
- taking values
290
nurses strategies to help prevent abuse
- know triggers
- know how to manage pt who demonstrate aggressive behvaiour
- learn about other cultural values
- communication skills
- peer support activities
- obtaining support from management
291
